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INTRODUCTION The incidence of diabetes continues to grow at a staggering pace. The United States' Centers for Disease Control and Prevention estimate that 23.6 million people or 7.8% of the U.S. Population has diabetes, with 1.6 million new cases being diagnosed each year. These figures are even more astonishing when one considers worldwide estimat...
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Diabetic peripheral neuropathy (DPN) is a widespread diabetes complication that affects up to 90% of individuals
living with diabetes. It is commonly divided in two forms based on the absence or presence of pain. It is well recognized that DPN is a powerful predictor of diabetic foot ulceration, and evidence establishes its role in the pathophysiol...
A frequent consequence of diabetes and a significant contributor to morbidity and mortality is diabetic foot ulcer (DFU).Early detection and appropriate management of DFUs are essential to prevent complications such as infections and lower extremity amputations. In recent years, medical imaging and machine learning have emerged as promising tools f...
![Pictorial representation of the experimental setup [49]](publication/359351629/figure/fig2/AS:1174305056530438@1656987551878/Pictorial-representation-of-the-experimental-setup-49_Q320.jpg)
In today’s scenario, Diabetes Mellitus (DM) is a major medical issue that comes with numerous complications. It is the most imperative disease associated with a diabetic foot. Among other conditions, one of the most common symptoms of diabetes is a diabetic foot ulcer. The early diagnosis of such foot perplexities, which may later lead to foot remo...
Objective
Diabetic foot ulcer, which often leads to lower limb amputation, is a devastating complication of diabetes that is a major burden on patients and the healthcare system. The main objective of this study is to determine the economic burden of diabetic foot ulcer-related care.
Methods
We conducted a multicenter study of all diabetic foot ul...
Background: Diabetic foot ulcers are a complication affecting approximately 15% of the total population with diabetes mellitus. There are three and half million diabetic patients in Saudi Arabia alone. Aim: to determine capacity building for nurses' knowledge and practice regarding prevention of diabetic foot complications. Research Questions: 1. D...
Citations
... In the past 20 years, there has been a significant emphasis on studying the knowledge, attitudes, and practices (KAP) of individuals with DM concerning the care of their feet [9,10]. The primary objectives of these studies were to identify barriers to seeking medical care, improve self-care practices, and promote lifestyle changes among diabetics. ...
Background Foot problems continue to be the leading cause of hospital admissions among people with diabetes. The objective of this study was to explore and assess the knowledge and attitudes of individuals about diabetic foot ulcers in the Asser region, Saudi Arabia. Methodology An anonymous, online, cross-sectional survey was conducted. The questionnaire was distributed through commonly used social media platforms such as Instagram, Facebook, and Twitter. Results A total of 445 participants were included in this survey. Overall, 37.1% (165) were aged 18-25 years, 64.3% (286) were women, and 75.7% (337) had university-level education. A significant number of participants had relatives with diabetes (57.1%, 254), while a smaller percentage reported having diabetes themselves (7.3%, 33), and a substantial proportion were neither diabetic nor had a relative with diabetes (35.6%, (158). Nearly two-fifths of the participants (37.8%, 168) received information about diabetes and diabetic foot care from physicians, and 34.1% (152) of the participants accessed information online. There were significant differences between those who did not have diabetes mellitus (DM) and those who had DM or whose relatives were diabetic in responses to the following questions: "Do you think that diabetes may cause gangrene in the foot?" (50.9% (205) vs. 45.7% (32), p = 0.019), "Do you think that preventing diabetic foot ulcers is more important than treating diabetic foot ulcers?" (60.8% (228) vs. 46.9% (60), p = 0.002), and "Do you think it is important to constantly monitor diabetic foot wounds?" (63.1% (200) vs. 30.4% (17), p < 0.001). There was a statistically significant difference between groups in the practice of daily foot checks, washing feet, moisturizing feet, keeping feet away from hot and cold, and nail care (p < 0.001). Conclusions The participants in the study showed a lack of knowledge regarding diabetic foot care, indicating the potential for better outcomes through the implementation of enhanced health education programs.
... Throughout the world, it is estimated that a leg is amputated every 30 seconds, and 85% of these amputations are due to diabetic foot ulcers. 5 This condition is developed by a diabetic neuropathy that coexists with peripheral artery disease (PAD), which accounts for more than half of major limb amputations in the United States, reaching 50.000 cases each year. 6 Several therapies have been used to prevent the worsening of diabetic foot ulcers. ...
Diabetes is a chronic metabolic disease that can lead to serious consequences that impair one's quality of life, if not adequately controlled. One of the undesirable complications is diabetic foot ulcer. It is estimated globally that every 30 seconds a leg is amputated due to diabetic foot, and thus can lower the quality of life. Recent studies have used a low-cost dye known as methylene blue as an anti-microorganism agent, and this sparks the idea of exploring more of its possible benefits. This literature review aimed to outline the beneficial roles of methylene blue in diabetic foot ulcer treatment. According to the findings, it is said that methylene blue may play a role as an anti-microorganism agent through its contribution in wound healing and invasive surgical prevention such as limb amputation. All the pooled articles showed a promising outcome of MB from the reduction of wound size in a shorter healing period with none adverse effects reported. Hence, methylene blue may have a promising role to be an effective agent in treating diabetic foot ulcer.
... The lifetime risk for the development of a foot ulcer in a patient with DM is estimated to be 19-34% [1]. Diabetes-related foot ulcers precede at least 60% of all nontraumatic lower limb amputations [2]. Moreover, even after the resolution of a foot ulcer, recurrence is also common [1]. ...
... Data were extracted by one author (BL) and supervised by a second author (YYC). The primary extracted data included (1) authors; (2) year of publication; (3) study design; (4) sample size; (5) length of follow-up; (6) follow-up rate; (7) sex, age, body mass index (BMI), glycosylated hemoglobin (HbA1c), and duration of diabetes; and (8) the intervention and outcomes of interest. In the present study, the main outcome of interest was the risk of DFU. ...
... Based on the definition of special 7 Journal of Diabetes Research therapeutic footwear in the latest IWGDF Practical Guidelines (2019), we collected data from all eligible RCTs on special footwear and obtained powerful evidence that further supported the recommendation on special footwear in the aforementioned guidelines. (2) In the overall analysis of the main outcome, we selected the random-effect model and the Hartung-Knapp-Sidik-Jonkman method, which could reduce type I error and generate more robust results, particularly in the presence of substantial heterogeneity and a limited number of enrolled studies [43]. (3) Based on the data from all relevant RCTs, we first found that longer intervention time period worsened the efficacy of special therapeutic footwear in preventing diabetes-related foot ulcers, which suggested that more attention should be given to the relationship between patients' compliance with special therapeutic footwear or special therapeutic footwear durability and the effect of therapeutic footwear. ...
Objective:
To reduce diabetic foot ulcer (DFU) occurrence or recurrence, diabetic therapeutic footwear is widely recommended in clinical practice for at-risk patients. However, the effectiveness of therapeutic footwear is controversial. Thus, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine whether special therapeutic footwear could reduce the incidence of DFU.
Method:
We systematically searched multiple electronic databases (Medline, EMBASE, and EMB databases) to identify eligible studies published from inception to June 11, 2021. The database search, quality assessment, and data extraction were independently performed by two reviewers. Efficacy (i.e., incidence of DFU) was explored using the R'meta' package (version 4.15-1). To obtain more robust results, the random-effects model and the Hartung-Knapp-Sidik-Jonkman method were selected to assess pooled data. Metaregression analysis and sensitivity analysis were performed to explore heterogeneity, and publication bias was assessed by a visual inspection of funnel plots and the AS-Thompson test.
Results:
Eight RCTs with a total of 1,587 participants were identified from the search strategy. Compared with conventional footwear, special therapeutic footwear significantly reduced the incidence of DFU (RR 0.49; 95% CI, 0.28-0.84), with no evidence of publication bias (P = 0.69). Unexpectedly, the effectiveness of special therapeutic footwear had a reverse correlation with the intervention time (coefficient = 0.085, P < 0.05) in the metaregression analysis.
Conclusion:
Special therapeutic footwear with offloading properties is effective in reducing the incidence of DFU. However, the effect may decrease gradually over time. Despite undefined reasons, the optimal utility time and renewal frequency of special therapeutic footwear should be considered.
... The most important step is to diagnose and treat as soon as possible soft tissue and bone infections. Nonvascular foot surgery, vascular foot surgery, and in some cases, necessity amputation are all options for diabetic foot surgical management [7,40]. A thorough evaluation should be performed, analysing the complexity of soft tissue defects and musculoskeletal pathological features. ...
Diabetic foot ulcer represents a very severe complication of diabetes mellitus, often requiring foot amputation, leading to morbidity and higher mortality rates. Around one in six diabetic patients develops foot ulcers over their lifetime. Promoting a series of preventive measures including systemic control of diabetes and other comorbidities along with local foot care proved to be a valuable strategy. In addition to rigorous, active prevention, multidisciplinary therapeutic management of diabetic ulcers includes offloading techniques, ulcer debridement, advanced dressings and diabetic foot surgical treatment. In this article, we analyze each component of this sequential treatment plan, with emphasis on current indications and resources, having as main goals decreasing complication rate and morbidity, improving the quality of life and life expectancy of diabetic patients.
... American Diabetic Society recommends that the individuals diagnosed with T2DM should undergo comprehensive evaluation for PAD at least once in 5 years even if they fall under normal ABI [15]. As per world health organization statistics, every 30 second, people are losing their part of the lower limb (amputation) [16]. However, in Indian community and clinical level practice, assessment of diabetic foot is not routinely incorporated leading to the negligence of the common complications of T2DM like neuropathy and peripheral artery disease. ...
Introduction: Ankle Brachial Index (ABI) is one of the common non-invasive diagnostic tools available for diagnosing Peripheral Arterial Disease (PAD). However, it has been observed that for an individual diagnosed with both PAD and Type 2 Diabetes Mellitus (T2DM), ABI tends to give false diagnostic value because of the calcification of the major lower limb arteries. Therefore, the health care professionals are at times misled for the diagnosis of PAD. To overcome this another diagnostic tool Toe Brachial Index (TBI) was suggested to perform. However, there is limited literature on performing both ABI and TBI in the given population in a single study.
Aim: The main focus of this study is to report the profile of ABI and TBI along with classical symptoms like claudication pain, palpation of pulse and history of T2DM for the screening and diagnosis of PAD in T2DM.
Materials And Methods: In this cross-sectional observational study, a total of 121 participants diagnosed with T2DM were recruited for the study as per the inclusion criteria. Detailed demographic details of the participants were noted. Diagnostic tool including both ABI and TBI were performed for all the participants and the data was analysed.
Results: Among 121 participants, only 3 participants had both ABI and TBI positive indicating positive diagnostic test for PAD and 106 participants had both ABI and TBI negative. However, in the remaining 12 participants, 10 showed TBI positive but ABI negative and 2 had ABI positive but TBI negative.
Conclusions: Based on our study we have reported the profile of PAD in T2DM individuals, which is found to be 10.75.%. Therefore, it can be concluded that ABI and TBI both should be performed to rule out any complication. This will be beneficial in early screening and detection of neuro ischemic changes in foot and subsequently to prevent amputation.
... American Diabetic Society recommends that the individuals diagnosed with T2DM should undergo comprehensive evaluation for PAD at least once in 5 years even if they fall under normal ABI [15]. As per world health organization statistics, every 30 second, people are losing their part of the lower limb (amputation) [16]. However, in Indian community and clinical level practice, assessment of diabetic foot is not routinely incorporated leading to the negligence of the common complications of T2DM like neuropathy and peripheral artery disease. ...
Justification . The ankle-brachial index (ABI) is a fairly common non-invasive method used to diagnose peripheral arterial disease (PAD). However, it has been noted that in patients diagnosed with PAD and type 2 diabetes mellitus (T2DM), ABI has no diagnostic value due to calcification of large arteries of the lower extremities. Thus, doctors can be misled about the diagnosis of PAD. For this, another diagnostic method was developed - the finger-brachial index (PIP). However, there is limited literature on the use of ABI and ABI in the same group within a single study.
Goal. The aim of this study is to describe the ABI and PPI profiles along with classic symptoms such as pain with claudication, pulse palpation, and a history of T2DM for screening and diagnosing PAD in T2DM.
Methods. To participate in this cross-sectional observational study, a group of 121 participants with an established diagnosis of T2DM was recruited in accordance with the inclusion criteria. Detailed demographic data of the participants were collected. All participants were diagnosed using the ABI and PPI diagnostic methods, and the findings were analyzed.
Results. Out of 121 participants, only 3 participants tested positive for both ABI and PPI, which means a positive PAD diagnosis; in 106 participants, both ABI and PPI showed negative results. However, among the remaining 12 participants, the following results were found: 10 participants had positive ABI and negative ABI, 2 participants positive ABI and negative ABI.
Conclusion. As a result of this study, we established PAD in T2DM in 10.75% of cases. Thus, we believe that both methods should be used to identify complications - ABI and PPI. This will play a certain positive role in the early diagnosis and establishment of neuroischemic changes in the foot and, accordingly, will avoid amputation.
Introduction
Diabetes related foot ulcers (DFUs) are common complications of type 2 diabetes mellitus (T2DM), affecting 15–25% of individuals living with diabetes and significantly contributing to healthcare costs ($9–13 billion annually in the U.S.). Without effective management, these wounds often lead to severe outcomes like amputations. This study aims to examine the association of semaglutide on DFU management.
Methods
This retrospective cohort study utilized TriNetX US Research Network data to assess the impact of semaglutide, a GLP-1 receptor agonist, on DFU outcomes between 2013 and 2023. The study compared outcomes between semaglutide users with DFU (Cohort A, N = 6329) and non-users with DFU (Cohort B, N = 118,821) across 64 healthcare organizations. We matched participants by age, gender, race, and ethnicity; however, we excluded patients with certain co-morbidities. Statistical analysis, such as chi-square analysis and risk ratio, using TriNetX software evaluated different complication outcomes.
Results
Semaglutide users with DFU demonstrated lower relative risks for complications compared to non-users. Within 1 year, semaglutide users were associated with lower relative risks for wound healing complications (0.19% vs 0.38%), chronic non-healing wounds (0.75% vs 1.23%), chronic pain (4.44% vs 8.06%), wound care (2.42% vs 4.86%), wound dehiscence (0.26% vs 0.56%), and amputation (2.34% vs 5.21%) ( p < .05). Similar trends persisted over 5 years. While these findings highlight potential benefits of semaglutide with patients with DFU, causation cannot be inferred due to the study’s observational design.
Conclusion
Semaglutide use was associated with favorable outcomes in patients with diabetes-related foot ulcers, including reductions in wound-related complications. While these findings suggest potential benefits of semaglutide as an adjunct in DFU management, further research is needed to confirm these associations and to better understand the mechanisms involved.
As the global burden of diabetes is rapidly increasing, the incidence of diabetic foot ulcers is continuously increasing as the mean age of the world population increases and the obesity epidemic advances. A significant percentage of diabetic foot ulcers are caused by mixed micro and macro-vascular dysfunction leading to impaired perfusion of foot tissue. Left untreated, chronic limb-threatening ischemia has a poor prognosis and is correlated with limb loss and increased mortality; prompt treatment is required. In this review, the diagnostic challenges in diabetic foot disease are discussed and available data on minimally invasive treatment options such as endovascular revascularization, stem cells, and gene therapy are examined.
There are a variety of dressings for wound healing. For this reason, research can assist in the choice and proper use of the intervention. This current view of the effectiveness of dressing on diabetic foot ulcers (DFUs) in patients with type 2 diabetes mellitus. This study is a systematic review of clinical trials selected in 4 databases: PubMed, Scopus, Web of Science, and Cochrane. Studies without language restriction, published between 2009 and 2020, were included. The search resulted in the identification of 5651 articles, of which 58 met all inclusion criteria. Among these, 2 biomaterials (D-acellular dermal matrix and keratinocyte) and phenytoin were highlighted for achieving healing rates of 100% and 95.82% ± 2.22%, respectively. The literature presents several alternatives with different actions, cure rates, reduction rates, and varied cost benefits. The growth in the use of biomaterials for the treatment of DFU can be seen in this study.
Background
Recurrence after the healing of a foot ulcer is very common among patients with diabetes mellitus. Novel diabetic therapeutic footwear consisted of merino wool, vibration chip, and orthopedic insoles is designed to influence multifaceted mechanisms of foot ulcer occurrence. The aim of this study is to examine the effect of the optimally designed therapeutic footwear on preventing ulcer recurrence in patients with a history of diabetic foot ulcers (DFU).
Methods/design
The trial is designed as a two arms, parallel-group, open-label randomized controlled intervention study. The Log-rank Test was used for calculating sample size based on the latest national multicenter survey data of DFU in China. Three hundred and twenty participants will be recruited from the Diabetic Foot Care Center, West China Hospital, Sichuan University. Adults with diabetic peripheral neuropathy, healed foot ulceration in the 3 months prior to randomization, and aged ≥18 years, will be recruited. Participants will be randomized to receive novel diabetic therapeutic footwear (n = 160) or their own footwear (n = 160). The primary outcome will be the incidence of ulcer recurrence. The secondary outcome will be measurements of barefoot dynamic plantar pressures, the influence of footwear adherence on ulcer recurrence, and the incidence of cardiovascular events. Assessment visits and data collection will be obtained at baseline, 1, 3, 6, 9, and 12 months. The intention-to-treat principle will be applied. A cox regression model will be used to calculate the hazard ratio for the incidence of ulcer recurrence. The change of barefoot dynamic plantar pressures will be assessed using repeated measures ANOVA. The study protocol has been approved by the Ethics Committee of The Biomedical Research Ethics Committee of West China Hospital, Sichuan University (Reference No. 2019(96)).
Discussion
This clinical trial will give information on the ability of novel diabetic footwear on preventing ulcer recurrence in patients with a history of diabetic foot ulceration. If the optimally designed therapeutic footwear does work well, the findings will contribute to the development of innovative treatment devices for preventing foot ulcer recurrence in high-risk patients.
Trial registration
Chinese Clinical Trial Registry ChiCTR1900025538. Registered on 31 August 2019.
