Question

How to prevent diabetic foot ulcers inthe form review of literature?

Answer 1

Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia resulting from either inadequate insulin production, reduced tissue sensitivity to insulin or both. Chronic hyperglycaemia leads to diabetic complications including peripheral neuropathy, peripheral vascular disease, increased risk of infection and poor wound healing. The diabetic foot may be defined as a group of syndromes in which neuropathy, ischaemia, and infection lead to tissue breakdown resulting in morbidity and possible amputation.1 This review of the literature will cover the nature and epidemiology of diabetic foot disease and how it may be prevented and managed, with an emphasis on studies from Africa. The review will be illustrated with local experience of establishing a diabetic foot service at Queen Elizabeth Hospital in Blantyre.

The global and local burden of diabetes

Globally the prevalence of noncommunicable diseases (NCDs) is rising rapidly and it is predicted that they will become the leading cause of mortality worldwide in the next 30 years.

The global prevalence of diabetes in the adult population was 8.5% in 2014.2 The greatest rate of increase will be in the developing countries of the world, including Malawi. Worldwide, deaths from diabetes are predicted to double between 2005 and 2030 and diabetic foot disease contributes significantly to this mortality.

In June 2010 the Malawi National STEPS study for noncommunicable diseases and their risk factors, described a countrywide survey of the prevalence of NCDs. In this, the prevalence of diabetes in adults aged 25 to 64 was estimated to be 5.6%,3 revealing that diabetes is becoming a significant public health problem in Malawi.

A number of factors contribute to the increasing number of people with, mainly type 2, diabetes in Malawi. The country is undergoing a rapid social and demographic transition. Low birth weight is common and low birth weight predisposes to adult diabetes.4 Furthermore, HIV treatment and even HIV itself can lead to the metabolic syndrome, which leads to the development of diabetes or can worsen the glycaemic control of patients with existing diabetes.5 Since Malawi has a very high prevalence of HIV this is likely to impact on the prevalence of diabetes especially since, with free access to ART drugs, people with HIV are living longer.

Answer 2

Diabetic foot ulcer is the most common complication of Diabetes mellitus, but usually fail to heal and leading to lower Limb amputation.
Early effective management of diabetic foot ulcer are:-
Blood sugar control, Wound debridement, education, advanced dressing, offloading advanced therapies etc.