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Background: The quantitative interpretation of the radiometric information extracted from infrared (IR) images in individuals with and without type 2 diabetes mellitus (DM2) is an open problem yet to be solved. This is of particular value given that DM2 is a worldwide health problem and onset for evolution toward diabetic foot disease (DFD). Since DM2 causes changes at the vascular and neurological levels, the metabolic heat distribution on the outer skin is modified as a consequence of such alterations. Of particular interest in this contribution are those alterations displayed over the skin's heat patterns at the lower limbs. At the core of such alterations is the deterioration of the vascular and neurological networks responsible for procuring systemic thermoregulation. It is within this context that IR imaging is introduced as a likely aiding tool to assist with the clinical diagnosis of DM2 at stages early enough to prevent the evolution of the DFD. Methods: IR images of lower limbs are acquired from a cohort of individuals clinically diagnosed with and without DM2. Additional inclusion criteria for patients are to be free from any visible wound or tissue‐related trauma (e.g., injuries, edema, and so forth), and also free from non‐metabolic comorbidities. All images and data are equally processed and analyzed using indices that evaluate the spatial and temporal evolution of temperature distribution in lower limbs. We studied the temporal response of individuals' legs after inducing an external stimulus. For this purpose, we combine the information of the asymmetry and thermal response index (ATR) and the thermal response index (TRI), computed using images at different times, improving the results previously obtained individually with ATR and TRI. Results: A novel representation of the information extracted from IR images of the lower limbs in individuals with and without DM2 is presented. This representation was built using the ATR and TRI indices for the anterior and posterior views (PVs), individually and combining the information from both views. In all cases, the information of each index and each view presents linearity properties that allow said information to be interpreted quantitatively in a well‐defined and limited space. This representation, built in a polar coordinate space, allows obtaining sensitivity values of 86%, 97%, and 97%, and specificity values of 83%, 72%, and 78% for the anterior view (AV), the PV, and the combined views, respectively. Additionally, it was observed that the angular variable that defines this new representation space allows to significantly (p < 0.01) differentiate the groups, while correlating with clinical variables of interest, such as glucose and glycated hemoglobin. Conclusion: The linearity properties that exist between the ATR and TRI indices allow a quantitative interpretation of the information extracted from IR images of the lower extremities of individuals with and without DM2, and allow the construction of a representation space that eliminates possible ambiguities in the interpretation, while simplifying it, making it accessible for clinical use. [ABSTRACT FROM AUTHOR]

No in-shoe systems, measuring both components of plantar load (plantar pressure and shear stress) are available for use in patients with diabetes. The STAMPS (STrain Analysis and Mapping of the Plantar Surface) system utilises digital image correlation (DIC) to determine the strain sustained by a deformable insole, providing a more complete understanding of plantar shear load at the foot-surface interface. What is the normal range and pattern of strain at the foot-surface interface within a healthy population as measured by the STAMPS system? Is STAMPS a valid tool to measure the effects of plantar load? A cross-sectional study of healthy participants was undertaken. Healthy adults without foot pathology or diabetes were included. Participants walked 20 steps with the STAMPS insole in a standardised shoe. Participants also walked 10 m with the Novel Pedar® plantar pressure measurement insole within the standardised shoe. Both measurements were repeated three times. Outcomes of interest were global and regional values for peak resultant strain (S MAG) and peak plantar pressure (PPP). In 18 participants, median peak S MAG and PPP were 35.01 % and 410.6kPa respectively. The regions of the hallux and heel sustained the highest S MAG (29.31 % (IQR 24.56–31.39) and 20.50 % (IQR 15.59–24.12) respectively) and PPP (344.8kPa (IQR 268.3 – 452.5) and 279.3kPa (IQR 231.3–302.1) respectively). S MAG was moderately correlated with PPP (r= 0.65, p < 0.001). Peak S MAG was located at the hallux in 55.6 % of participants, at the 1st metatarsal head (MTH) in 16.7 %, the heel in 16.7 %, toes 3–5 in 11.1 % and the MTH2 in 5.6 %. The results demonstrate the STAMPS system is a valid tool to measure plantar strain. Further studies are required to investigate the effects of elevated strain and the relationship with diabetic foot ulcer formation. • STAMPS was developed to measure the effect of plantar load. • Peak plantar strain correlated moderately with peak plantar pressure. • The hallux and heel were the regions of highest strain and plantar pressure. • Peak plantar strain coincided with the region of callus in 83 % of participants. [ABSTRACT FROM AUTHOR]

AimsWerner Syndrome is a rare premature ageing autosomal recessive disorder caused by pathogenic variants in the WRN gene. People with Werner Syndrome may develop diabetes mellitus. Chronic foot ulceration is seen, with some characteristics overlapping with diabetic foot disease. However, the clinical course of the ulceration is atypical of diabetic foot disease. We present four siblings from an Irish Traveller family with Werner Syndrome to highlight the complexity of this condition. The Irish Traveller population are an indigenous, endogamous population in which consanguinity is common. As a result, rare autosomal recessive disorders are prevalent among this population:. Methods: We describe our experience managing the complex foot disease seen in all four siblings. Foot complications present in the siblings include painful peripheral neuropathy, chronic foor ulceration, underlying osteomyelitis and acral melanoma. Results: The cases are described individually, with a particular focus on the complex foot disease associated with the condition. Conclusions: Although the siblings attend a diabetic foot clinic, we suggest that the combination of clinical features seen in these cases is unique to Werner syndrome and warrants the title 'Werner Syndrome' (rather than 'Diabetic') foot. [ABSTRACT FROM AUTHOR]

Diabetic foot disease can drastically alter a patient's life and is linked to high burdens on society, including costs, mortality and morbidity. In 2022, the Vascular Society Diabetic Foot Specialist Interest Group (VSDFSIG), in association with the James Lind Alliance (JLA), published the key research priorities for preventing and managing diabetic foot disease. Multidisciplinary healthcare professionals, along with patients and carers, identified the top priorities using a Delphi consensus methodology. These include prevention of diabetic foot ulcers, treatments for infected diabetic foot ulcers, improving diabetic foot ulcer healing and access to specialist services. The VSDFSIG are now leading in the development research strategies to generate impactful evidence in these key areas and urge podiatrists, who are key members of the diabetic foot team, to be involved through leading, developing and participating in the developing research programmes. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONThis study aims to adapt and validate the Foot Health Status Questionnaire, developed by Bennett et al., in Portuguese patients with diabetic foot.A cross-sectional study was conducted with 143 patients with diabetic foot. A principal component analysis with oblique rotation and a confirmatory factor analysis using structural equation modeling were performed.The Portuguese version of the FHSQ (FHSQ-PT) in patients with diabetic foot remains equal to the original version, although with all factors correlated with each other. All scales presented high internal consistency values (pain: ω = 0.884; function: ω = 0.890; general foot health: ω = 0.910; and footwear: ω = 0.702), except for the footwear scale, although with a minimum acceptable coefficient. The FHSQ-PT scales showed good convergent validity and good discriminant validity. The FHSQ-PT scales were also able to discriminate between male and female patients as well as between patients with an active diabetic foot ulcer from those who did not.The results of the validated FHSQ-PT for Portuguese patients with diabetic foot showed good psychometric properties, being a useful, objective, and small instrument that may be used in clinical practice by health professionals without consuming too much time.Diabetic foot ulcer has been consistently reported to be associated to lower health-related quality of life, impairing the patient’s everyday function.Validated comprehensive measures that assess specific dimensions related to foot health in patients with diabetic foot are needed.The Portuguese version of the Foot Health Status Questionnaire (FHSQ-PT) showed good psychometric properties.FHSQ-PT is a useful short instrument that may be used to measure foot health status in clinical practice by health professionals who provide care to patients with diabetic foot.Diabetic foot ulcer has been consistently reported to be associated to lower health-related quality of life, impairing the patient’s everyday function.Validated comprehensive measures that assess specific dimensions related to foot health in patients with diabetic foot are needed.The Portuguese version of the Foot Health Status Questionnaire (FHSQ-PT) showed good psychometric properties.FHSQ-PT is a useful short instrument that may be used to measure foot health status in clinical practice by health professionals who provide care to patients with diabetic foot. [ABSTRACT FROM AUTHOR]

Abstract Background To evaluate the association between diabetic foot disease (DFD) and the incidence of fatal and non-fatal events in individuals with type 2 diabetes (T2DM) from primary-care settings. Methods We built a cohort of people with a first DFD episode during 2010–2015, followed up until 2018. These subjects were 1 to 1 propensity score matched to subjects with T2DM without DFD. The incidence of all-cause mortality, the occurrence of new DFD, amputations, cardiovascular diseases, or composite outcome, including all-cause mortality and/or cardiovascular events during the follow-up period, were calculated. A Cox proportional hazard analysis was conducted to evaluate the hazard ratios (HR) for different events. Results Overall, 11,117 subjects with T2DM with a first episode of DFD were compared with subjects without DFD. We observed higher incidence rates (IRs) for composite outcome (33.9 vs. 14.5 IR per 100 person-years) and a new DFD episode event (22.2 vs. 1.1 IR per 100 person-years) in the DFD group. Compared to those without DFD, those with a first episode of DFD had a higher HR for all events, with excess rates particularly for amputation and new DFD occurrence (HR: 19.4, 95% CI: 16.7–22.6, HR: 15.1, 95% CI: 13.8–16.5, respectively) was found. Conclusions Although DFD often coexists with other risk factors, it carries an intrinsic high risk of morbidity and mortality in individuals with T2DM. DFD should be regarded as a severe complication already at its onset, as it carries a poor clinical prognosis. Graphical Abstract

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Background: To evaluate the association between diabetic foot disease (DFD) and the incidence of fatal and non-fatal events in individuals with type 2 diabetes (T2DM) from primary-care settings. Methods: We built a cohort of people with a first DFD episode during 2010–2015, followed up until 2018. These subjects were 1 to 1 propensity score matched to subjects with T2DM without DFD. The incidence of all-cause mortality, the occurrence of new DFD, amputations, cardiovascular diseases, or composite outcome, including all-cause mortality and/or cardiovascular events during the follow-up period, were calculated. A Cox proportional hazard analysis was conducted to evaluate the hazard ratios (HR) for different events. Results: Overall, 11,117 subjects with T2DM with a first episode of DFD were compared with subjects without DFD. We observed higher incidence rates (IRs) for composite outcome (33.9 vs. 14.5 IR per 100 person-years) and a new DFD episode event (22.2 vs. 1.1 IR per 100 person-years) in the DFD group. Compared to those without DFD, those with a first episode of DFD had a higher HR for all events, with excess rates particularly for amputation and new DFD occurrence (HR: 19.4, 95% CI: 16.7–22.6, HR: 15.1, 95% CI: 13.8–16.5, respectively) was found. Conclusions: Although DFD often coexists with other risk factors, it carries an intrinsic high risk of morbidity and mortality in individuals with T2DM. DFD should be regarded as a severe complication already at its onset, as it carries a poor clinical prognosis. [ABSTRACT FROM AUTHOR]

This study will explore the effectiveness of fish skin grafts (FSG) in ulcer healing in diabetic foot disease compared to standard of care (SOC). The systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. The electronic databases of PubMed, EMBASE, and Web of Science (WoS) internet were searched for the outcome rate of complete ulcer healing. The risk of bias assessment was conducted using the tool recommended by the Cochrane Collaboration. Statistical analysis included the individual and combined result of the studies, heterogeneity test, the effect size, sensitivity analysis, and publication bias tests. Five randomised controlled trials (RCTs) with a total of 411 patients were included in this study. This meta-analysis showed a higher rate of complete ulcer healing in groups receiving fish skin grafts (OR = 3.34, 95% CI 2.14–5.20, p < 0.01, I2 = 0%) compared to control groups. Fish skin grafts have been shown to be more effective for achieving complete ulcer healing compared to current conventional treatments in diabetic foot disease. • Foot complications are one of the leading causes of hospitalisation in patients with diabetes mellitus, demanding prolonged stays. • 15% of the diabetic population will develop diabetic foot disease during their disease, with 25% of them leading to lower limb amputation. • The current standard hospital treatments for patients with diabetic foot disease, do not guarantee success in their closure. • Fish skin grafts is a highly efficient treatment considering its cost and effectiveness in the ability to stimulate cell proliferation and differentiation. [ABSTRACT FROM AUTHOR]

Abstract Objectives: Identifying the risk factors that lead to diabetic foot disease and taking precautions is associated with a reduction in the occurrence of diabetic foot ulcers and the rate of amputation. The patient plays the most important role in that regard. This study aimed to investigate the knowledge, attitudes, and behaviors of diabetic patients, who underwent follow-up at a tertiary health center, about foot care and diabetic foot disease. Materials and Methods: The study included 327 patients aged over 18 years, who presented to the Endocrinology and Metabolic Diseases clinic and outpatient clinic of a tertiary health center. The data were obtained using socio-demographic information and laboratory results of the subjects, information about diabetes, and responses to the diabetic foot disease awareness scale in this descriptive study. Results: The patients were grouped based on diabetic foot behaviors as follows: 79 (24.15%) patients as lowscore, 144 (44.03%) patients as medium-score, and 104 (31.80%) patients as high-score. There were significant differences between the groups by education and employment status, body weight, body mass index (BMI), waist circumference, type of diabetes mellitus (DM), duration (years), diabetes education, foot care education, treatment, exercise, and diabetic foot examination statuses. Conclusion: Diabetic foot awareness was low in our patient group. The most important factor to increase awareness of diabetic foot disease and to prevent diabetic foot ulcers is to ensure that individuals with diabetes receive education on general diabetes and foot care and to incorporate their learnings into their behaviors. [ABSTRACT FROM AUTHOR]

Lymphoedema is the gradual, abnormal build-up of lymph fluid in the tissues resulting from a failure of the lymphatic system. The swelling impedes movement and is painful. Compression garments are contraindicated and not tolerated by patients with extensive peripheral arterial disease. In this case study, simple lymphatic drainage was therefore considered a safer treatment option to reduce oedema and to encourage proactive self-management for a patient with bilateral amputations, diabetes and peripheral arterial disease. [ABSTRACT FROM AUTHOR]

Prompt referral of patients with diabetic foot ulceration (DFU) to specialist services can lead to more timely assessment of these patients and subsequent improved rates of limb salvage and patient outcomes. In this study we wanted to determine the impact of education in the primary care setting on onward referrals to our specialist Diabetic Foot multi-disciplinary team (MDT) clinic. As part of a Diabetic Foot Roadshow, four teaching sessions were delivered in primary care settings across Shropshire by our specialist team from 17th March to the 25th May 2022. Attendees included podiatrists, tissue viability nurses, district nurses and wound care practitioners. Hospital records were used to identify all onward referrals to our Diabetic Foot MDT clinic in the weeks before and after delivery of the roadshow education sessions. 184 referrals were made to the diabetic foot clinic from January to July 2022. There were 0.3 referrals per day in the months prior to the commencement of the education sessions, compared to 1.5 referrals per day following the commencement of the teaching sessions. This increase in referrals was statistically significant (p < 0.0001). Teaching sessions delivered to community specialist healthcare professionals significantly increase onward referral of patients to specialist services, facilitating more timely assessment and management of patients with DFUs. • Prompt referral of patients with diabetic foot ulceration (DFU) to specialist services is essential to outcomes. • Education programmes in the primary care setting can improve onward referral of patients. • Improving referral rates allows patients to be reviewed at earlier stages of disease. • This has the potential to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: There remains a paucity of research comparing the diagnostic and therapeutic outcomes between Magnetic Resonance Imaging (MRI) and x-ray modalities for Charcot neuro-osteoarthropathy CNO. This retrospective study investigates the use of offloading devices, duration of offloading and final footwear outcomes dependent on imaging at diagnosis. Methods: Medical records from a secondary hospital high-risk foot clinic in Perth, Western Australia, were systematically reviewed. Data collected included baseline medical history, location of CNO, Eichenholtz stage or Chantelau and Grutznel grade at diagnosis, type and duration of offloading, and final footwear outcomes. Results: Twenty-eight patients met the inclusion criteria. All had diabetes and peripheral neuropathy. All patients received either an MRI (43%) or x-ray (57%) to confirm the diagnosis of active CNO. Five (17.9%) patients who were diagnosed on MRI had grade 0 CNO whilst 23 (82.1%) patients who were diagnosed on x-ray had stage 1 CNO. No statistical significance was found between the type and duration of offloading, resolution of CNO, footwear and transtibial amputation (TTA) outcomes across those diagnosed with MRI or x-ray. Conclusion: No statistical significance in patient outcomes was found between those diagnosed with grade 0 on MRI and those diagnosed with stage 1 on x-ray.

Objective assessment of the diabetic foot at risk, and we also explore the role of understanding biomechanics, which is essential to determining risk of foot disease, but also the potential for recurrence. In addition, we discuss the evidence linking depression and cognitive impairment to diabetic foot disease and offer our insight on the research direction required before implementing novel information into front-line clinics. [ABSTRACT FROM AUTHOR]

This paper summarized the integrated traditional Chinese and western medicine nursing based on integration of medical care for pain management in a patient with diabetic foot disease complicated with erysipelas. An integration team of medical care specialists was established for consultation instruction, evaluation, diagnosis, treatment and nursing. Based on the syndrome differentiation, integrative nursing measures included Chinese herbal medicine application, Traditional Chinese Medicine collapse stains, acupuncture and health education before discharge from hospital were carried out to relieve the pain and improve the quality of life of the patient. (本文总结医护一体化模式下1例糖尿病足合并丹毒患者的中西医结合疼痛护理经验。组建医护一体化小组, 医护相互协作, 根据医生的中医辨证, 从专科方面进行指导, 制订中西医结合护理措施, 开展中药贴敷、中药塌渍、针刺治疗、出院指导等全方面、整体连续性的护理措施, 有效减轻患者疼痛, 提高生活质量。)

Objective To explore and summarize the experience of early screening of diabetic foot disease (DFD) in community and the construction of DFD database standard. Methods Electronic data capture system (EDC) was established to input and collect data to build DFD database, after unifying data elements by referring to domestic and foreign guidelines in related fields under the guidance of multidisciplinary experts and standardized collation, compilation of case report forms (CRF), classification of tasks and unified pre-screening training according to the results of field research in different communities. It had to ensure that the work information from each post-assembly line was input into the EDC in real time, and at the same time, the Clinical Research Associate (CRA) conducted real-time and spot checks for quality control, and regular meetings and summary seminars provided timely feedback and revision. Results In this study, the early screening indicators of DFD included 54 sub-items and 7 forms, which were divided into basic information, medical history information, physical examination, laboratory examination, auxiliary examination, living conditions and follow-up records. According to the different levels of the forms, three CRF were compiled: basic, enrolment and follow-up information form. Information from DFD database such as peripheral artery disease (PAD), loss of protective sensation (LOPS), foot deformity, history of foot ulcer, history of lower limb amputation and history of end-stage renal disease were summarized and used to classify the high risk of diabetic foot, and follow-up was carried out at different frequencies according to the classification. Conclusion The early community screening and database construction of DFD are not mature enough and the process is complicated, which needs to be standardized, adapted to local conditions, simplified and constantly updated. [ABSTRACT FROM AUTHOR]

The term 'diabetic foot disease' (DFD) often signifies the presence of foot ulceration and infection, but one must also be wary of the rarer occurrence of Charcot foot disease. The worldwide prevalence of DFD is 6.3% (95%CI: 5.4-7.3%). Foot complications present a major challenge to both patients and healthcare systems, with increased rates of hospitalisation and an almost trebled 5-year mortality. The Charcot foot often occurs in patients with long-standing diabetes, presenting as an inflamed or swollen foot or ankle, following unrecognised minor trauma. This review focuses on the prevention and early identification of the 'at-risk' foot. DFD is best managed by a multi-disciplinary foot clinic team consisting of podiatrists and healthcare professionals. This ensures a combination of expertise and provision of a multi-faceted evidence-based treatment plan. Current research using endothelial progenitor cells (EPC) and mesenchymal stem cells (MSC) offers a new dimension in wound management. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to clarify any gender differences in the mortality risk of people with DFD since patients with diabetic foot disease (DFD) are at a high risk of mortality and, at the same time, are more likely to be men. Methods: From regional administrative sources, the survival probability was retrospectively evaluated by the Kaplan-Meier method and using the Cox proportional-hazards model comparing people with DFD to those without DFD across the years 2011–2018 in Tuscany, Italy. Gender difference in mortality was evaluated by the ratio of hazard ratios (RHR) of men to women after initial DFD hospitalizations (n = 11,529) or in a cohort with prior history of DFD hospitalizations (n = 11,246). Results: In both cohorts, the survival probability after DFD was lower among women. Compared to those without DFD, after initial DFD hospitalizations, the mortality risk was significantly (18%) higher for men compared to women. This excess risk was particularly high after major amputations but also after ulcers, infections, gangrene, or Charcot, with a lower reduction after revascularization procedures among men. In the cohort that included people with a history of prior DFD hospitalizations, except for the risk of minor amputations being higher for men, there was no gender difference in mortality risk. Conclusions: In people with DFD, the overall survival probability was lower among women. Compared to those without DFD after a first DFD hospitalization, men were at higher risk of mortality. This excess risk disappeared in groups with a history of previous DFD hospitalizations containing a greater percentage of women who were older and probably had a longer duration of diabetes and thus becoming, over time, progressively frailer than men. [ABSTRACT FROM AUTHOR]

To investigate the effect of integration of medical care for pain control of a patient with diabetic foot gangrene complicated with infection. The clinical data of a patient with diabetic foot gangrene complicated with infection were retrospectively analyzed. Based on the integration of medical care, integrated Traditional Chinese and western medicine nursing interventions such as integration nursing ward round, Traditional Chinese Nursing technique, emotion nursing and health education were carried out to relieve the pain caused by diabetic foot gangrene and improve the patients’ quality of life. (探讨医护协作护理模式在脱疽(糖尿病足坏疽合并感染)患者疼痛护理中的应用效果。回顾性分析科室收治的1例糖尿病足坏疽合并感染患者的临床资料, 通过运用医护一体化护理模式, 给予患者中西医结合护理, 包括医护一体化查房、中医护理技术、情志护理和健康指导, 旨在有效缓解疼痛, 提高患者生活质量 。)

This paper summarized the nursing of integrated Traditional Chinese and western medicine for a patient with diabetic foot ulcer on the right foot. According to the different stage if wound healing, the Traditional Chinese Medicine external application therapy by syndrome differentiation was carried out to improve the debridement effect, help healthy tissue grow and minimize scarring. Based on the evidence-based nursing, individualized health education and nursing program were developed to improve the wound healing of the patient with diabetic foot ulcer. (本文总结1例糖尿病右足溃疡患者伤口的护理经验。根据辩证, 在不同时期给予中药外治法祛腐排脓、推陈出新、生肌收口, 同时基于循证护理, 加强健康教育, 制定个体化护理方案, 加快患者伤口愈合。)

Diabetes mellitus contributes to 15–25% of all chronic foot ulcers. Peripheral vascular disease is a cause of ischemic ulcers and exacerbates diabetic foot disease. Cell-based therapies are viable options to restore damaged vessels and induce the formation of new vessels. Adipose-derived stem cells (ADSCs) have the potential for angiogenesis and regeneration because of their greater paracrine effect. Preclinical studies are currently using other forced enhancement techniques (e.g., genetic modification or biomaterials) to increase the efficacy of human ADSC (hADSC) autotransplantation. Unlike genetic modifications and biomaterials, many growth factors have been approved by the equivalent regulatory authorities. This study confirmed the effect of enhanced human ADSC (ehADSC)s with a cocktail of FGF and other pharmacological agents to promote wound healing in diabetic foot disease. In vitro, ehADSCs exhibited a long and slender spindle-shaped morphology and showed significantly increased proliferation. In addition, it was shown that ehADSCs have more functionalities in oxidative stress toleration, stem cell stemness, and mobility. In vivo, the local transplantation of 1.2 × 106 hADSCs or ehADSCs was performed in animals with diabetes induced by STZ. The ehADSC group showed a statistically decreased wound size and increased blood flow compared with the hADSC group and the sham group. Human Nucleus Antigen (HNA) positive cells were observed in some ADSC-transplanted animals. The ehADSC group showed a relatively higher portion of HNA-positive animals than the hADSC group. The blood glucose levels showed no significant difference among the groups. In conclusion, the ehADSCs showed a better performance in vitro, compared with conventional hADSCs. Additionally, a topical injection of ehADSCs into diabetic wounds enhanced wound healing and blood flow, while improving histological markers suggesting revascularization. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot disease is a complication of the complications due to chronic hyperglycemic changes in the vessels and nerves. Many mechanisms are involved in its pathogenesis, but not all of them are fully elucidated. Body mass index (BMI) is known to correlate with met abolic diseases and their severity. The role of adipose tissue and the cytokines that it produces in diabetic foot disease is poorly studied. Methods: In a cross-sectional study 120 hospitalized patients with type 2 diabetes mellitus and mean age of 57,68±10,47 years, aged between 32 and 79 years, were included. They were divided into 2 groups – people with diabetic foot disease – with an existing diabetic plantar ulcer on the foot (n=42) and those without this complication (n=78). Standard anthropometric, physical and laboratory examinations were performed on all participants. Their body composition was determined using a bioimpedance method. Results: Patients with diabetic foot were significantly older, had a longer history of diabetes, lower BMI, body weight and hip circumference, as well as having less body fat. The number of metabolic syndrome components was significantly lower among individuals with diabetic wounds, compared to those without this complication. All women in the diabetic foot group were in menopause. Conclusion: In our study, higher adipose tissue content correlated with lower incidence of diabetic foot disease. The presentation of this complication fits the definition of the “obesity paradox.” [ABSTRACT FROM AUTHOR]

Aims/hypothesis: Diabetic foot disease (DFD) is a leading cause of hospital admissions and amputations. Global trends in diabetes-related amputations have been previously reviewed, but trends in hospital admissions for multiple other DFD conditions have not. This review analysed the published incidence of hospital admissions for DFD conditions (ulceration, infection, peripheral artery disease [PAD], neuropathy) and diabetes-related amputations (minor and major) in nationally representative populations. Methods: PubMed and Embase were searched for peer-reviewed publications between 1 January 2001 and 5 May 2022 using the terms 'diabetes', 'DFD', 'amputation', 'incidence' and 'nation'. Search results were screened and publications reporting the incidence of hospital admissions for a DFD condition or a diabetes-related amputation among a population representative of a country were included. Key data were extracted from included publications and initial rates, end rates and relative trends over time summarised using medians (ranges). Results: Of 2527 publications identified, 71 met the eligibility criteria, reporting admission rates for 27 countries (93% high-income countries). Of the included publications, 14 reported on DFD and 66 reported on amputation (nine reported both). The median (range) incidence of admissions per 1000 person-years with diabetes was 16.3 (8.4–36.6) for DFD conditions (5.1 [1.3–7.6] for ulceration; 5.6 [3.8–9.0] for infection; 2.5 [0.9–3.1] for PAD) and 3.1 (1.4–10.3) for amputations (1.2 [0.2–4.2] for major; 1.6 [0.3–4.3] for minor). The proportions of the reported populations with decreasing, stable and increasing admission trends were 80%, 20% and 0% for DFD conditions (50%, 0% and 50% for ulceration; 50%, 17% and 33% for infection; 67%, 0% and 33% for PAD) and 80%, 7% and 13% for amputations (80%, 17% and 3% for major; 52%, 15% and 33% for minor), respectively. Conclusions/interpretation: These findings suggest that hospital admission rates for all DFD conditions are considerably higher than those for amputations alone and, thus, the more common practice of reporting admission rates only for amputations may substantially underestimate the burden of DFD. While major amputation rates appear to be largely decreasing, this is not the case for hospital admissions for DFD conditions or minor amputation in many populations. However, true global conclusions are limited because of a lack of consistent definitions used to identify admission rates for DFD conditions and amputations, alongside a lack of data from low- and middle-income countries. We recommend that these areas are addressed in future studies. Registration: This review was registered in the Open Science Framework database (https://doi.org/10.17605/OSF.IO/4TZFJ). [ABSTRACT FROM AUTHOR]

The objective was to review the orthopaedic literature on treatments of diabetic foot disease. Material and methods PubMed, CyberLeninka, Google Scholar, Scopus, Medline, eLIBRARY were searched. Studies in English and in Russian that reported foot deformities in the pathogenesis of diabetic foot disease and orthopaedic correction methods in the complex treatment of this late complication of diabetes mellitus were included for review. All study designs were considered. The search was produced using the following terms: diabetes mellitus, foot deformities, diabetic foot syndrome, orthopaedic treatment, osteotomy, metatarsophalangeal arthroplasty, achilles tendon lengthening. Literature sources reporting methods of orthopaedic correction of foot deformities in isolation from the diabetic foot syndrome and literary sources reporting manifestations of the diabetic foot syndrome without description orthopedic methods of treatment (surgery for purulent complications, vascular surgery, hypoglycemic therapy) were excluded from the study. Results The literature review allowed us to evaluate the role of orthopaedic treatment of foot deformities in patients with diabetic foot syndrome to be addressed either conservatively or surgically. The effectiveness of conservative methods has long been reported in studies with higher degree of evidence. Surgical correction of DFS through orthopaedic interventions has not been covered in such detail. Conclusion The literature review focused on the topical issue at the junction of various medical specialties. The results of treatment reported by Russian and foreign authors were analyzed. "Blind spots" in the literature were explored, goals for subsequent research delineated.

Background and Objectives: Diabetic foot (DF) disease is one of the myriad complications of diabetes. Positive outcomes are expected through a multidisciplinary approach as provided by primary care providers (PCPs). This study aimed to assess the knowledge of DF and attitude of physicians in primary healthcare settings toward DF diagnosis and prevention in Saudi Arabia. Materials and Methods: This observational cross-sectional study used a self-administered questionnaire that was completed by family medicine consultants, residents, and general practitioners working in primary care settings in Riyadh. Results: Of the 152 physicians who completed the survey, (43.4%) completed more than 10 h of diabetes continuing medical education (CME) over the past three years. Most (96.1%) PCPs educate patients about foot self-inspection, and only (64.5%) perform foot inspection at every visit in high-risk diabetic foot patients. PCP knowledge about diagnosing and managing diabetic foot infection was suboptimal. Only 53.9% of participants reported performing a probe-to-bone in DF patients with open wounds. Conclusions: We identified knowledge and action gaps among PCPs. Physicians had acceptable knowledge about preventive measures. However, deficits were found regarding diagnosing and management of DF infections. We recommend addressing these knowledge gaps by incorporating DF lectures and workshops within family medicine conferences and residency programs. [ABSTRACT FROM AUTHOR]

Diabetic foot disease is a common and serious complication for diabetes and is characterized with impaired angiogenesis. Nurses are the primary providers of prevention and early diagnosis of diabetes and its complications. This paper summarized the role of clinical nurse specialist in prevention of diabetic foot disease, diabetic foot care and prevention of diabetic foot wounds. In terms of nursing, nurses are responsible for the observation of change in foot soft tissue and skin sensitivity, as well as foot care, dressing and use of the new technologies. In terms of rehabilitation, clinical nurse specialist are responsible for the exercise guidance and health education for patients with foot ulcer and amputated limbs (糖尿病足是糖尿病常见并发症之一, 护士是积极参与预防和早期发现糖尿病及其并发症的卫生保健提供者。本文概述了护士, 尤其是糖尿病专科护士, 在糖尿病足预防和护理中重要作用。在护理方面, 护士负责早期发现皮肤和足部感觉的变化, 开展足部护理、敷料和新技术的应用; 在康复领域, 糖尿病专科护士负责指导和帮助糖尿病足溃疡或截肢患者进行活动。)

Background: Our study aimed to assess the prevalence of diabetic foot disease (DFD) and its associated risk factors among subjects attending primary care centers in Catalonia (Spain). Methods: We undertook a cross-sectional analysis of data from the primary health care (SIDIAP) database. The presence of comorbidities and concomitant medication were analyzed for subjects with or without DFD. DFD prevalence was estimated from 1st January 2018 to 31st December 2018. Results: During the 12-month observational period, out of 394,266 people with type 2 diabetes, we identified 3,277 (0.83%) active episodes of DFD in the database. The majority of these episodes were foot ulcers (82%). The mean age of patients with DFD was 70.3 (± 12.5) years and 55% were male. In the multivariable descriptive models, male gender, diabetes duration, hypertension, macrovascular, microvascular complications, and insulin and antiplatelet agents were strongly associated with DFD. A previous history of DFD was the stronger risk factor for DFD occurrence in subjects with T2DM (OR: 13.19, 95%CI: 11.81; 14.72). Conclusions: In this real-world primary care practice database, we found a lower prevalence of DFD compared to similar previous studies. Risk factors such as male sex, duration of diabetes, diabetes complications and previous history of DFD were associated with the presence of DFD. [ABSTRACT FROM AUTHOR]

Background: Adequate nutrition is essential in individuals with diabetic foot ulceration (DFU); therefore, an assessment of dietary intake is critical. A lack of nutrients including protein, zinc and vitamins C and D have all been associated with poor wound healing. However, the comprehensive dietary intake of Australian adults with DFU is poorly understood. The aim of this cross‐sectional study was to describe the dietary intake of adults with DFU in an Australian setting. Methods: Participants (n = 115) with diabetes (type 1 and 2), a mean body mass index of 36 and current foot ulceration were recruited from across New South Wales, Australia. Dietary intake was assessed using the Australian Eating Survey, a self‐reported validated food frequency questionnaire. Results: The mean (SD) reported energy intake was 9.57 (±SD 4.43) MJ day–1. A mean protein intake of 104 (±SD 49) g day–1 is below recommended intake for wound healing; however, the mean protein intake contribution to energy (19%E) was within recommendations for normal populations. The mean carbohydrate intake (43%E) was within recommended ranges for healthy populations; however, the mean total fat intake (36%E) was above recommendations. Micronutrient intake was adequate, apart from folate, which was below the recommended intake, and sodium, vitamin C, vitamin A and selenium, which were above the recommended intake. Conclusions: A lack of adequate folate may have a negative impact on healing, with folate proposed to play a role in tissue repair. Wound management of individuals with DFU should include a regular assessment of dietary intake to recognise deficiencies in macro‐ and micronutrients, and subsequently address these inadequacies to optimise healing. Key points: This cross‐sectional study of 115 participants with active diabetic foot ulceration aimed to describe current dietary intake.Utilising a validated food frequency questionnaire, the Australian Eating Survey, it was found that mean protein intake was inadequate for wound healing (9.57 MJ day–1).Intake of folate was also inadequate, which may have implications for tissue repair.Wound management of individuals with diabetic foot ulceration should include an assessment of dietary intake to recognise deficiencies in macro‐ and micronutrient intake and subsequently address these to optimise healing outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Weight‐bearing physical activity is important for people with diabetes‐related foot disease but may also contribute to ulceration or delayed ulcer healing. No overview of weight‐bearing activity of people at different stages of foot disease is available. We aimed to summarise quantitatively measured daily activity levels in people with diabetes‐related foot disease. Methods: We systematically searched peer‐reviewed literature for studies reporting objectively measured weight‐bearing activity in people with diabetes‐related foot disease. We calculated daily step counts' means (over studies) and weighted means (over participants). International Working Group on the Diabetic Foot (IWGDF) risk strata, different climates, and activity indoors versus outdoors were compared. Results: From 1247 publications, 27 were included. Mean steps/day in people with IWGDF risk 1/2: 6125 (12 studies; 345 participants; weighted mean: 5384). In IWGDF risk 3: 6167 (8 studies; 291 participants; weighted mean: 6239). In those with a foot ulcer: 4248 (6 studies; 186 participants; weighted mean: 4484). People living in temperate oceanic climates are more active compared to those in hotter or more humid climates (mean steps/day for no ulcer: 7712 vs. 5224 [18 studies]; for ulcer: 6819 vs. 2945 [6 studies]). People are more active indoors than outdoors (mean 4047 vs. 2514 [3 studies]). Conclusion: Levels of weight‐bearing physical activity are similar between people with diabetes at various risk levels for foot ulceration but lower for those with a foot ulcer. Weight‐bearing activity differs depending on the climatological environment and is higher indoors than outdoors. These findings provide reference for intervention studies or for clinicians aiming to provide mobility advice in this population. [ABSTRACT FROM AUTHOR]

BackgroundOur study aimed to assess the prevalence of diabetic foot disease (DFD) and its associated risk factors among subjects attending primary care centers in Catalonia (Spain).MethodsWe undertook a cross-sectional analysis of data from the primary health care (SIDIAP) database. The presence of comorbidities and concomitant medication were analyzed for subjects with or without DFD. DFD prevalence was estimated from 1st January 2018 to 31st December 2018.ResultsDuring the 12-month observational period, out of 394,266 people with type 2 diabetes, we identified 3,277 (0.83%) active episodes of DFD in the database. The majority of these episodes were foot ulcers (82%). The mean age of patients with DFD was 70.3 (± 12.5) years and 55% were male. In the multivariable descriptive models, male gender, diabetes duration, hypertension, macrovascular, microvascular complications, and insulin and antiplatelet agents were strongly associated with DFD. A previous history of DFD was the stronger risk factor for DFD occurrence in subjects with T2DM (OR: 13.19, 95%CI: 11.81; 14.72).ConclusionsIn this real-world primary care practice database, we found a lower prevalence of DFD compared to similar previous studies. Risk factors such as male sex, duration of diabetes, diabetes complications and previous history of DFD were associated with the presence of DFD.

Werner syndrome is an autosomal recessive rare disease caused by a WRN gene mutation, which is rarely reported in the Chinese population. We report the clinical and genetic data of a Chinese patient with Werner syndrome. The proband was a 40-year-old male patient who presented with diabetic foot ulcers, accompanied by short stature, cataracts, hypogonadism, and hair thinning, and myelodysplastic syndrome (MDS) occurred after 18 months. Genetic sequencing showed there were compound heterozygous mutations as c.3384-1G>C and c.3744dupA in the WRN gene. The c.3744dupA mutation is a novel pathogenic variation for Werner syndrome. [ABSTRACT FROM AUTHOR]

Aim: We aimed to compare the mortality of individuals at low, moderate, and high risk of diabetic foot disease (DFD) in the context of newly diagnosed type 2 diabetes, before developing active diabetic foot problem. Methods: This was a population-based cohort study of adults with newly diagnosed type 2 diabetes utilizing IQVIA Medical Research Data. The outcome was all-cause mortality among individuals with low, moderate, and high risk of DFD, and also in those with no record of foot assessment and those who declined foot examination. Results: Of 225,787 individuals with newly diagnosed type 2 diabetes, 34,061 (15.1%) died during the study period from January 1, 2000 to December 31, 2019. Moderate risk and high risk of DFD were associated with increased mortality risk compared to low risk of DFD (adjusted hazard ratio [aHR] 1.50, 95% CI 1.42, 1.58; aHR 2.01, 95% CI 1.84, 2.20, respectively). Individuals who declined foot examination or who had no record also had increased mortality risk of 75% and 25% vs. those at low risk of DFD, respectively (aHR 1.75, 95% CI 1.51, 2.04; aHR 1.25, 95% CI 1.20, 1.30). Conclusion: Individuals with new-onset type 2 diabetes who had moderate to high risk of DFD were more likely to die compared to those at low risk of DFD. The associations between declined foot examination and absence of foot examinations, and increased risk of mortality further highlight the importance of assessing foot risk as it identifies not only patients at risk of diabetic foot ulceration but also mortality. [ABSTRACT FROM AUTHOR]

Foot complications are the most common cause of hospital admission of people with diabetes and a frequent cause of amputation. Neuropathy and peripheral arterial disease make the foot particularly vulnerable to ulceration, but infection is often the pathology precipitating presentation. Recognition of the patient at risk of ulceration may allow interventions to prevent the development of foot complications. When complications do occur, urgent treatment is required to prevent limb loss; the infected foot in a patient with diabetes is a surgical emergency. In addition to antibiotics, debridement and surgical drainage of infection should be considered within the first 24 hours after presentation. Once the foot is made safe, revascularization should be undertaken in those with significant arterial disease. Adoption of a multidisciplinary team approach to managing diabetic foot complications has resulted in reduction in major amputations in some European countries. [ABSTRACT FROM AUTHOR]

(随着经济的持续发展, 非传染性慢性病已取代传染性疾病严重威胁人类的健康, 而慢性伤口糖尿病足的护理成为亟待解决的问题。本文以糖尿病足患者为研究对象, 了解患者无能为力感现状, 探讨影响无能为力感的重要影响因素, 进一步明确作用机制, 旨在增强医护人员对糖尿病足患者无能为力感的重视, 为患者制定针对性的护理干预措施提供参考依据。)

Background: Diabetic foot ulcers are one of the most common lower extremity complications of diabetes, with the lifetime risk of a person developing a DFU estimated to be as high as 34%. It is recommended that those with diabetes receive an annual review of their feet, by a trained healthcare professional, to identify risk factors for ulceration and allow for subsequent risk stratification, patient education and provision of appropriate care to prevent ulceration and amputation. Internationally, while many countries have a diabetic foot care pathway, it is not a structured population health screening programme unlike other areas of preventive care for people with diabetes such as retinopathy screening. A structured diabetic foot screening pathway could allow for earlier identification of the at-risk foot. However, the introduction of any population screening programme should meet the Wilson and Jungner principles of screening. This paper presents a protocol for a scoping review of existing evidence on screening for the at-risk-foot against the Wilson and Junger principles. Methods: The scoping review will be conducted in line with the six-stage methodological framework by Arksey & O’Mally and the Joanna Briggs Institute (JBI) scoping review methodology. Medline (EBSCO), Scopus, ScienceDirect and EMBASE databases will be searched. Studies relating to the burden of diabetic foot ulcers, their pathophysiology and screening tests for peripheral neuropathy and peripheral artery disease, and screening programmes will be included. A data extraction tool will be used to facilitate a chronological narrative synthesis of results. Results: These will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR). Conclusion: This scoping review will evaluate and map the evidence surrounding diabetic foot ulcers using the Wilson and Jungner principles of screening as a framework.

Diabetic kidney disease favors diabetic foot ulcers, however we do not know whether the reverse relation exists. We investigated whether diabetic foot disease (DFD) related to an increased risk of developing renal events. We conducted a retrospective analysis of a cohort of patients hospitalized for type 2 diabetes mellitus (T2DM) between 2009 and 2017, stratified for the risk of diabetic foot ulcer grades 0 (no risk), 1 and 2 (at risk), and 3 (DFD) according to the International Work Group on Diabetic Foot (IWGDF) classification. We highlighted new renal events (end-stage renal disease or a doubling of serum creatinine) in their medical records until December 2020. The relationship between DFD and later renal events was analyzed by multivariable Cox regression model. Among 519 patients, 142 (27 %) had a DFD at baseline, and 159 (30 %) were classified as Grades 1 or 2. Thirty-six renal events occurred during the 54 ± 27 months of follow-up: 19 subjects started dialysis, 1 had a renal transplantation, and 16 had a doubling of serum creatinine: 15 each in subjects with DFD and subjects at risk, versus 6 in subjects with Grade 0 DFD (logrank: P = 0.001). Adjusted for i) age and sex; ii) hyperglycemic exposure; iii) conventional cardiovascular risk factors; iv) renal parameters: and v) new diabetic foot ulcers during follow-up, DFD (HR 2.7 to 5.9) and being at risk of DFD Grades 1–2 (HR 2.8 to 5.1) were significantly related to new renal events. The risk of renal events was increased in people with T2DM and DFD. [ABSTRACT FROM AUTHOR]

Diabetes mellitus contributes to 15–25% of all chronic foot ulcers. Peripheral vascular disease is a cause of ischemic ulcers and exacerbates diabetic foot disease. Cell-based therapies are viable options to restore damaged vessels and induce the formation of new vessels. Adipose-derived stem cells (ADSCs) have the potential for angiogenesis and regeneration because of their greater paracrine effect. Preclinical studies are currently using other forced enhancement techniques (e.g., genetic modification or biomaterials) to increase the efficacy of human ADSC (hADSC) autotransplantation. Unlike genetic modifications and biomaterials, many growth factors have been approved by the equivalent regulatory authorities. This study confirmed the effect of enhanced human ADSC (ehADSC)s with a cocktail of FGF and other pharmacological agents to promote wound healing in diabetic foot disease. In vitro, ehADSCs exhibited a long and slender spindle-shaped morphology and showed significantly increased proliferation. In addition, it was shown that ehADSCs have more functionalities in oxidative stress toleration, stem cell stemness, and mobility. In vivo, the local transplantation of 1.2 × 106 hADSCs or ehADSCs was performed in animals with diabetes induced by STZ. The ehADSC group showed a statistically decreased wound size and increased blood flow compared with the hADSC group and the sham group. Human Nucleus Antigen (HNA) positive cells were observed in some ADSC-transplanted animals. The ehADSC group showed a relatively higher portion of HNA-positive animals than the hADSC group. The blood glucose levels showed no significant difference among the groups. In conclusion, the ehADSCs showed a better performance in vitro, compared with conventional hADSCs. Additionally, a topical injection of ehADSCs into diabetic wounds enhanced wound healing and blood flow, while improving histological markers suggesting revascularization.

Aims: A diabetic foot ulcer (DFU) is a severe condition associated with morbidity and mortality. Population‐based studies are rare and limited by access to reliable data. Without this data, efforts in primary prevention cannot be evaluated. Therefore, we examined the incidence and changes over time for the first DFU in people with diabetes. We also examined hospitalization and all‐cause mortality and their changes over time. Methods: From the UK primary care CPRD GOLD database (2007–2017), we identified 129,624 people with diabetes by a prescription for insulin or a non‐insulin anti‐diabetic drug. DFUs were identified using Read codes and expressed as incidence rates (IRs). Changes over time were described using Poisson and logistic regression and expressed as incidence rate ratios (IRRs) and odds ratios (ORs) respectively. Results: The mean IR of first registered DFUs was 2.5 [95% CI: 2.1–2.9] per 1000 person‐years for people with type 2 diabetes and 1.6 [1.3–1.9] per 1000 person‐years for people with type 1. The IRs declined for people with type 2 diabetes (IRR per year: 0.97 [0.96–0.99]), while no changes were observed for people with type 1 diabetes (IRR per year: 0.96 [0.89–1.04]). Average hospitalization and 1‐year mortality risk for people with type 2 diabetes were 8.2% [SD: 4.7] and 11.7% [SD: 2.2] respectively. Both declined over time (OR: 0.89 [0.84, 0.94] and 0.94 [0.89, 0.99]). Conclusion: The decline in all IRs, hospitalizations and mortality in people with type 2 diabetes suggests that prevention and care of the first DFU has improved for this group in primary care in the UK. [ABSTRACT FROM AUTHOR]

Background: There is a lack of high quality evidence to guide the optimal management of diabetes-related foot infection, particularly in cases of severe diabetes-related foot infection and diabetes-related foot osteomyelitis. This study examined the opinions of surgeons about the preferred management of severe diabetes-related foot infection. Methods: Vascular and orthopaedic surgeons in Australia and New Zealand were invited to complete an online survey via email. The survey included multi-choice and open-ended questions on clinical management of diabetes-related foot infection. Responses of vascular surgeons and orthopaedic surgeons were compared using non-parametric statistical tests. Open-text responses were examined using inductive content analysis. Results: 29 vascular and 20 orthopaedic surgeons completed the survey. One-third (28.6%) used best-practice guidelines to assist in decisions about foot infection management. Areas for guideline improvement identified included more specific advice regarding the indications for available treatments, more recommendations about non-surgical patient management and advice on how management can be varied in regions with limited health service resource. The probe-to-bone test and magnetic resonance imaging were the preferred methods of diagnosing osteomyelitis. Approximately half (51.2%) of respondents indicated piperacillin combined with tazobactam as the preferred antibiotic choice for empirical treatment of severe diabetes-related foot infection. Negative pressure wound therapy was the most common way of managing a wound following debridement. All vascular surgeons (100%) made revascularisation decisions based on the severity of ischemia while most orthopaedic surgeons (66.7%) were likely to refer to vascular surgeons to make revascularisation decisions. Vascular surgeons preferred using wound swabs while orthopaedic surgeons favoured tissue or bone biopsies to determine the choice of antibiotic. Respondents perceived a moderate variation in management decisions between specialists and supported the need for randomised controlled trials to test different management pathways. Conclusions: Most vascular and orthopaedic surgeons do not use best-practice guidelines to assist in decisions about management of diabetes-related foot infection. Vascular and orthopaedic surgeons appear to have different preferences for wound sampling to determine choice of antibiotic. There is a need for higher quality evidence to clarify best practice for managing diabetes-related foot infection. [ABSTRACT FROM AUTHOR]

Qin Yang, Yingxiao Zhang, Qinglian Zeng, Chan Yang, Jiale Shi, Chunlin Zhang, Xia Ni, Zhipeng Du, Ziwei Tang, Jinbo Hu, Xuemei Li, Jiahui Cai, Qifu Li, Qingfeng Cheng Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Qingfeng ChengThe First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400042, People’s Republic of ChinaTel +86-23-89011510Fax +86-23-890115540Email cqf19760516@163.comPurpose: The present study was designed to determine the relationships between sarcopenia and diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM) and diabetic foot disease (DFD) respectively.Patients and Methods: A total of 1104 patients with T2DM and 257 patients with DFD were included in the study, which was designed as a cross-sectional study. Body composition was assessed using dual-energy X-ray-absorptiometry (DXA). The diagnosis of sarcopenia was based on the Baumgartner criteria. DPN was assessed by Neuropathy symptom score (NSS) and Neuropathy disability score (NDS), and the severity of neuropathy was divided into non-neuropathy symptom (NS), Mild NS, Moderate NS and Severe NS according to NSS. Logistic regression analyses were carried out to determine the relations of sarcopenia and DPN in patients with T2DM and NSS in patients with DFD, respectively.Results: The prevalence of DPN was 80.0% in T2DM patients with sarcopenia and 70.3% in non-sarcopenia patients (P=0.007). Logistic regression analyses showed DPN was one of the independent risk factors for sarcopenia in T2DM patients (OR 1.564 [95% CI: 1.004, 2.435], P=0.048). The prevalence of DPN had no statistical significance in DFD patients with or without sarcopenia. However, the NSS of DFD patients with sarcopenia was higher than that of non-sarcopenia patients. In the multivariate logistic regression analysis, NSS was determined to be associated with sarcopenia in DFD patients (OR 1.387[95% CI: 1.074, 1.789], P=0.012). The appendicular lean mass (ALM) of DFD patients without NS was higher than patients with mild, moderate and severe NS (20.71± 2.73 vs 16.57± 3.62 vs 17.99± 3.54 vs 17.23± 3.29 Kg, P=0.028).Conclusion: DPN is an independent risk factor for sarcopenia in patients with T2DM and NSS is also independently correlated with sarcopenia in patients with DFD, with the latter being more obvious with the aggravation of neurological symptoms in DFD patients.Keywords: type 2 diabetes mellitus, diabetic peripheral neuropathy, diabetic foot disease, sarcopenia, correlation

Abstract Background There is a lack of high quality evidence to guide the optimal management of diabetes‐related foot infection, particularly in cases of severe diabetes‐related foot infection and diabetes‐related foot osteomyelitis. This study examined the opinions of surgeons about the preferred management of severe diabetes‐related foot infection. Methods Vascular and orthopaedic surgeons in Australia and New Zealand were invited to complete an online survey via email. The survey included multi‐choice and open‐ended questions on clinical management of diabetes‐related foot infection. Responses of vascular surgeons and orthopaedic surgeons were compared using non‐parametric statistical tests. Open‐text responses were examined using inductive content analysis. Results 29 vascular and 20 orthopaedic surgeons completed the survey. One‐third (28.6%) used best‐practice guidelines to assist in decisions about foot infection management. Areas for guideline improvement identified included more specific advice regarding the indications for available treatments, more recommendations about non‐surgical patient management and advice on how management can be varied in regions with limited health service resource. The probe‐to‐bone test and magnetic resonance imaging were the preferred methods of diagnosing osteomyelitis. Approximately half (51.2%) of respondents indicated piperacillin combined with tazobactam as the preferred antibiotic choice for empirical treatment of severe diabetes‐related foot infection. Negative pressure wound therapy was the most common way of managing a wound following debridement. All vascular surgeons (100%) made revascularisation decisions based on the severity of ischemia while most orthopaedic surgeons (66.7%) were likely to refer to vascular surgeons to make revascularisation decisions. Vascular surgeons preferred using wound swabs while orthopaedic surgeons favoured tissue or bone biopsies to determine the choice of antibiotic. Respondents perceived a moderate variation in management decisions between specialists and supported the need for randomised controlled trials to test different management pathways. Conclusions Most vascular and orthopaedic surgeons do not use best‐practice guidelines to assist in decisions about management of diabetes‐related foot infection. Vascular and orthopaedic surgeons appear to have different preferences for wound sampling to determine choice of antibiotic. There is a need for higher quality evidence to clarify best practice for managing diabetes‐related foot infection.

Background and Objectives: Diabetic foot (DF) disease is one of the myriad complications of diabetes. Positive outcomes are expected through a multidisciplinary approach as provided by primary care providers (PCPs). This study aimed to assess the knowledge of DF and attitude of physicians in primary healthcare settings toward DF diagnosis and prevention in Saudi Arabia. Materials and Methods: This observational cross-sectional study used a self-administered questionnaire that was completed by family medicine consultants, residents, and general practitioners working in primary care settings in Riyadh. Results: Of the 152 physicians who completed the survey, (43.4%) completed more than 10 h of diabetes continuing medical education (CME) over the past three years. Most (96.1%) PCPs educate patients about foot self-inspection, and only (64.5%) perform foot inspection at every visit in high-risk diabetic foot patients. PCP knowledge about diagnosing and managing diabetic foot infection was suboptimal. Only 53.9% of participants reported performing a probe-to-bone in DF patients with open wounds. Conclusions: We identified knowledge and action gaps among PCPs. Physicians had acceptable knowledge about preventive measures. However, deficits were found regarding diagnosing and management of DF infections. We recommend addressing these knowledge gaps by incorporating DF lectures and workshops within family medicine conferences and residency programs.

Diabetic foot problems are among the most debilitating complications of diabetes mellitus. These problems incur significant economic costs and reduce quality of life. The integration of thermography technology in the screening and management of diabetic foot problems has been proven to be successful in recent years. By detecting changes in temperature, thermography helps identify early infections and assists in patient monitoring. These early successes have inspired more research and publications in this field. To date, a comprehensive bibliometric analysis of thermography-related research on diabetic foot using the Scopus database has not been conducted. This bibliometric analysis aims to fill this gap by reviewing the Scopus database from its inception until 2023 to examine the literature on thermography-related research on diabetic foot. A total of 342 articles met the selection criteria and were included in this analysis. The number of articles in this field remained low until the 2010s, when there was a sudden surge of interest that prompted numerous publications. Authors from the USA contributed the highest number of articles and had the greatest scholarly impact in this field. Despite the major contribution from the USA, there were numerous collaborations between various countries, underscoring the importance of international collaboration in advancing research and exchanging knowledge., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Zakaria et al.)

Background and Objectives: To propose a new classification of diabetic foot syndrome adapted for inclusion in the ICD-10 (the ICD-10 is the 10th revision of the International Statistical Classification of Diseases) and providing more reliable data on the number of clinical cases. Materials and Methods: A randomized controlled trial was performed. A total of 180 patients (36.6%) discharged from the hospital after surgical treatment and 312 patients (63.4%) who applied independently were observed and analysed. All patients had type 2 diabetes and were comparable in gender, age, duration of diabetes, area and nature of the wound defect. Results: We proposed to add the following to the existing ICD-10 and the emerging ICD-11 codes: Edf10.0--insulin-dependent diabetes mellitus with diabetic foot syndrome and Edf11.0--non-insulin-dependent diabetes mellitus with diabetic foot syndrome, where "df" is an acronym for diabetic foot. The new classification designates the seven most frequent areas of the lesion and five degrees of depth of soft tissue lesions. Conclusions: The proposed classification adapted for ICD-10 will enable the standardisation of diagnosis, providing a complete picture of this complication of diabetes mellitus, determining the number of amputations and their validity. Accurate statistics will allow for objective funding and timely preventive measures. [ABSTRACT FROM AUTHOR]

Background Existing evidence suggests that adherence to treatment plans and long-term lifestyle modifications could reduce costly complications associated with diabetes, such as diabetic foot ulcers (DFU). Applying biopsychosocial models and theories to practice can help clinicians understand why individuals adopt or reject certain health behaviours. Aims This review explores the dynamic between patients' psychosocial behaviours and their levels of commitment to treatment plans, discusses approaches for improving the therapeutic relationship between health care professionals (HCPs) and patients through collaborative healthcare planning and raises awareness of the importance of identifying the psychological barriers to managing outcomes of chronic illnesses. Methods This is a narrative exploration of health belief theories applied to managing diabetes and DFU, including a discussion of 'compliance', 'adherence' and 'concordance'; health psychology theories on adherence behaviours; and the role of emotional responses in influencing the acceptance of long-term treatments. Findings Evidence highlighted the role of psychosocial factors in influencing a person's decision-making process and noted individual differences in the willingness to conform to certain health and treatment recommendations, based on prior assumptions and knowledge extending beyond a longer-term conception of the benefits and risks of behaviours or disease progression. Conclusions Healthcare planning should shift from labelling patients as 'non-compliant' toward promoting collaborative conversations that inform choices and actions. HCPs should acknowledge the importance of patients' knowledge and views about their health and create treatment plans that best suit these individual needs. Future research should develop health belief models to incorporate patients' emotional responses to chronic illness. [ABSTRACT FROM AUTHOR]

This study will explore the effectiveness of autologous platelet-rich plasma in the treatment of diabetic foot disease compared to conventional treatments, based on the ulcer healing rate. The electronic databases of PubMed, EMBASE, and WOS internet were searched. Evaluated outcome rate of complete ulcer healing. Statistical analysis was performed with RevMan 5.0 software and SPSS 25.0. Eleven RCTs with 828 patients were included in this study. The meta-analysis showed a higher complete ulcer healing rate (OR = 3.69, 95 % CI 2.62 to 5.20, P < 0.01, I2 = 0 %) in growth factors based in autologous platelech-rich plasma (aPRP) group compared with control. Mixed evidence was seen for publication bias, but analyses by using the trim-and-fill method did not appreciably alter results. Autologous platelet-rich plasma can improve the complete healing rate of the ulcer compared to current conventional treatments in diabetic foot ulcer patients. • Foot complications in diabetic patients are a major cause of extended hospital stays. • 15% of diabetics will develop foot disease, with 25% of cases resulting in lower limb amputation. • The current standard hospital treatments for patients with diabetic foot disease, do not guarantee success in their closure. • Using aPRP is a cost-effective and highly efficient treatment that effectively stimulates cell proliferation and differentiation. [ABSTRACT FROM AUTHOR]