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In recent years, novel methods and concepts for the treatment of diabetic foot disease have emerged worldwide. This article summarizes the progress of clinical practice of diabetic foot, focuses on the revascularization of diabetic foot combined with lower limb arterial disease, such as endovascular debulking, drug-coated balloon and tibial transverse transport surgery, and the new wound repair technology of diabetes foot ulcer, such as stem cell therapy, platelet-rich gel and antibiotic loaded bone cement, and briefly introduces phage therapy.
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Objective To investigate the relationship between heart rate variability ( HRV) and chronic complications in pa-tients with type 2 diabetes mellitus (T2DM).Methods A total of 96 patients with T2DM was given chronic complication assessment . Demographic data were obtained .Diabetic retinopathy , diabetic kidney disease , diabetic peripheral neuropathy ( DPN) , and peripher-al artery disease ( PAD) were diagnosed according to international clinical classification .The parameters of HRV in the patients with diabetes and non-diabetes were examined with24 h Holter recorder .Results The HRV parameters of type 2 diabetic patients were significantly lower than those of non-diabetes ( P <0.05 ) .HRV time domain parameters [ standard deviation of normal RR intervals (SDNN), standard deviation of 5-minute mean RR intervals (SDANN), root mean square difference among successive RR normal in-tervals ( RMSSD) ] were especially impaired in diabetic patients with retinopathy compared to those without retinopathy .HRV parame-ters except low-to-high frequency ratio ( LF/HF) and MNN were lower in diabetic patients with kidney disease than those without kid-ney disease .HRV parameters were no significant difference between patients with or without PAD .Conclusions HRV of diabetic pa-tient is lower.Diabetic retinopathy and kidney disease impact on the HRV .
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The professional care by multi-disciplinary team and priority of prevention should be carried out in the treatment of diabetic foot disease to reduce diabetic amputation.This article describes the professional experience in the treatment of four complicated cases with diabetic foot disease and emphasizes the importance of the co-operation among different specialists,including diabetologists and wound,vascular,orthopedic surgeons,etc.as well as of varied therapies applied in staged management of the diabetic foot care,by treating these patients with diabetic foot disease as early as possible.
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Objective To determine the mortality and associated risk factors in the patients with diabetic foot ulcers. Methods One hundred and sixty-three patients with diabetic foot ulcers hospitalized from January 2001 to December 2006 were followed up until December 2009. Mortality rates were derived from Kaplan-Meier survival curves. The prognostic factors were evaluated with Cox proportional hazard model. Results Follow-up was successful in 139 out of 163 patients, with a mean follow-up period of(3.71 + 1. 80)years. 55 patients(39 males and 16 females)died during the follow-up. The 5-year mortality was 45.8% and mean survival time was 5.38 years(95% CI 4.87-5.89). The median survival time was 6.83 years. Age, smoking, hypertension, coronary artery disease, and diabetic nephropathy were found to be independent prognostic factors for mortality. Conclusions Diabetic foot ulcers increased the mortality of diabetic patients. Age, smoking, hypertension, coronary artery disease, and diabetic nephropathy were predictive risk factors for mortality.
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Objective To evaluate the effective of weight loss on blood glucose,lipid profile,and blood pressure in over-weight or obesity patients combined with impaired glucose tolerance(IGT).Methods Body weight of 91 over-weight or obesity IGT patients were managed by doctors and nurses.Body weight,waist circumference,blood glucose,lipid profile,blood pressure and liver function of the patients were compared at 3 months with baseline.Results After 3 months' intervention,the levels of body weight,waist circumference,fasting plasma glucose,postprandial glucose,systolic blood pressure,diastolic blood pressure,and glutamie oxalacetie transaminase (COT),instead of triglyeeride and hish-density lipoprotein cholesterol (HDL-C),were significantly reduced.Over weight or obesity IGT patients saw a 1.8 and 2.3 kg body weight loss,respectively.Decreased plasma glucose and blood pressure were found both in the over-weight group and in the obesity groups,but decreased waist circumference and GOT were found only in the over-weight patients.Conclusions Body-weight control may improve the blood glucose,blood pressure,central obesity,or fatty liver in over weight or obesity IGT patients.For those obesity patients,longer and stronger body weight control should be needed.
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Objective To evaluate the feasibility and diagnostic accuracy of CE-MRA with low dose contrast agent by comparison with DSA in diabetic patients with peripheral arterial diseases. Methods ( 1 )Study in vitro: test tubes containing Gd-DTPA of different concentrations were scanned, and the relationship between signal intensities and concentrations of GD-DTPA was analyzed. DSA and CE-MRA with selected concentrations of Gd-DTPA were performed on stenotic vascular models to estimate the proper low dose of GD-DTPA for clinical applications. (2) Clinical applications: 78 diabetic patients with peripheral arterial diseases were scanned from the abdomen and pelvis station to the calf-foot station in a 3 T MR system with standard bolus chase 3D CE-MRA sequence after injection of 13 ml GD-DTPA . The image quality,diagnostic rate of stenosis of arteries in calf and degree of venous contamination were evaluated with Fisher's exact test. DSA images of 220 vascular segments in 22 patients ( 10 segments per patient) were acquired as the gold standard and compared with CE-MRA by using Kappa test. Results The MR signal intensities were proportional to the concentrations of contrast agent in present study, and all stenotic segments of vascular model were displayed by CE-MRA with GD-DTPA at lower concentration of 1.5 mmol/L. As for MRA images of 78 diabetic patients with low dose Gd-DTPA, about 97.4% (76/78) showed diagnostic image quality for pelvic and thigh stations. But the MRA images of lower extremities were interfered by the venous contamination significantly (P ＜ 0.01 ). Compared with DSA for 22 patients, the diagnostic sensitivity, specificity and agreement coefficient (Kappa value) of MRA were 96. 0% ( 168/175), 73.3%(33/45), and 0.72 (P＜0.01), respectively. Conclusion Using 3.0 T MR scanner, high quality CE-MRA of lower limb arteries can be obtained for clinical applications with contrast agent dose as low as 13 ml,which has comparable diagnostic sensitivity and specificity with DSA. But the limitation of venous contamination in MRA image should be resolved in further studies.
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Objective To evaluate biochemical characteristics and the trend of diabetic complications in patients with newly-diagnosed type 2 diabetes from 1994 to 2008. Methods We utilized the database of the diabetes complications assessment and analyzed the metabolic disorder and the diabetic complications in the patients with newly diagnosed diabetes. Results 2 085 cases were collected, including 1189 males and 896 females. The average age of onset of diabetes was 51.6±13.1 and 54.6±7.9 yrs respectively in 2008 and 1994. During 1994,no case was found in subjects aged 20-29 yrs and 5% of the patients were aged 30-39; but 2% of patients aged 20-29 and 16% aged 30-39 yrs were found in 2008. BMI was increased from 24.48±4.15 in 1994 to 26.03±3.63 in 2008. Percentage of patients with abnormal BMI ( ≥25 kg/m2 ), WHR [≥0.90 (male) or ≥0.85 (female)]increased significantly from 63.6%, 75.0%, and 71.4% in 1994 to 79.6%, 95.2%, and 93.8% in 2008,respectively. Both SBP and DBP were not significantly changed. The fasting blood and postprandial blood glucose,HbA1c decreased from 10.3 mmol/L, 15.2 mmol/L, 11.1% in 1994 to 9.0 mmol/L, 14.3 mmol/L, and 8.6% in 2008, respectively. The average TG level increased from 1.7 mmol/L in 1994 to 2. 1 mmol/L in 2008,however, TC and HDL level were not significantly changed. The prevalence of diabetic retinopathy decreased from 28.2% in 1994 to 3.9% in 2008. The prevalence of diabetic nephropathy increased from 17.7% in 1994 to 24.6% in 2008. The prevalence of diabetic cardiovascular disease increased from 14.3% in 1994 to 24. 1% in 2008. Compared with the patients without microvascular complications, the patients with microvascular complications had higher SBP, DBP, and HbA1c( 136/78 vs 130/77 mm Hg, 9.41% vs 9.11% ). The patients with macrovascular complications had older age, higher SBP, TC, and TG than those without macrovascular complications (53.4 vs 50.0 yrs; 132 vs 129 mm Hg ; 5.3 vs 5.1 mmol/L and 2.6 vs 2.1 mmol/L). Conclusions In the studied newly-diagnosed diabetic patients from 1994 to 2008, there were increasing incidences of obesity and hypertriglyceridemia. However, the prevalence of diabetic retinopathy decreased significantly, while that of nephropathy showed no significant change.Cardiovascular complications were markedly increased.
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According to the alanine aminotransferase (ALT)level, 4 509 patients were assigned into group A (n=449, with raised ALT)and group B (n=4 060, normal ALT). Between the patients of group A and B, differences existed in age [(48.5 ± 11.3 vs 55.7 ± 11.4) years, P＜0.01], duration of diabetes [( 36.8 ±45.0 vs 56.2±58.8 ) months, P＜0. 01], body mass index[BMI, (27.7±3.9 vs 25.8±3.4) kg/m2, P＜0.01], waist-tohip ratio (0.95±0.06 vs 0. 93±0.07, P＜0. 01 ), diastolic blood pressure [( 78± 10 vs 75± 10) mm Hg, 1 mm Hg=0. 133 kPa, P＜0. 01], fasting blood glucose [(9.04±2.91 vs 8.63 ±3.05 ) mmol/L, P = 0. 008], 2 h blood glucose after meal[( 13.85±4.67 vs 13.07 ± 4. 92 ) mmol/L, P=0. 002], HbA1c(8. 11% ± 1.82% vs 7.74% ±1.96%, P＜0. 01 ), fasting serum insulin[( 10.59±7.31 vs 7.97±7.18) mU/L, P＜0. 01], postprandial insulin [(48.96±43.80 vs 35.25 ±32.37 ) mU/L, P＜0. 01], homeostasis model assessment for insulin resistance ( HOMA-IR, 4.11±-2.85 vs 3.00 ± 2.92, P＜ 0. 01 )、 triglycerides [( 2.77 ± 2.50 vs 2. 19 ± 2.99 ) mmol/L, P＜0. 01], and high-density lipoprotein-cholesterol [HDL-C, ( 1.20 ± 0. 30 vs 1.29 ± 0. 83 ) mmol/L, P = 0. 01].Logistic regression analysis showed that HbA1C, postprandial insulin, and HOMA-IR, uric acid and urinary albumin were positively, and HDL-C negatively related with the ALT level. It suggests that raised ALT seems to be an index related to the clustering of cardiovascular risk factors, insulin resistance, and earlier onset of type 2 diabetes.
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A total of 2794 diabetic patients admitted in the PLA Hospital N. 306 from 2000 to 2004 were analyzed for their in-patients cost, based on database according to the ICD-9 code and the standard forms for the investigation of medical expenditure. The average total medical cost of these in-patients Was 6557,6887,8235,9633 and ll785 RMB Yuan (1 US Dollar=8.1 RMB Yuan) from 2000 to 2004, respectively. Comparing with that in 2000, the average medical cost for these in. patients increased 5%,26%,47% and 80% from 2001 to 2004, respectively; of which 17%,19%,47% and 96% for drugs; 5%,29%,56% and 92% for the examinations. The total medical cost, drug and examination cost increased 1.01,1.14 and 1.10 times for the diabetic patients with cerebral infarction, 1.16,1.37 and 1.12 times with hypertension, and 1.124,1.11 and 1.18 times with cholecystitis and/or gallstones, as compared with their counterparts without diabetes mellitus.
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Objective To compare and analyze the metabolic control with the islet B cell function and the diabetic complications after a 3-year treatment in type 2 diabetic patients.Methods The T2DM patients were investigated who finished 3 years of treatment.The following measurements or determination was done:height,weight,waist,hips,blood pressure at standing and lying position,fasting glucose and insulin,glucose and insulin 2 h after taking food,HbA_1c,TC,TG,HDL-C,LDL-C,Cr,albuminuria and retinopathy.Results Totally 233 male and 178 female(56.53?10.33)yrs patients were analysized.The hypotensive,hypoglycemic and lipids agents were increased obviously and the number of the patients with insulin treatment increased too.HbA_1c was decreased,but no significant differences for the blood pressure and blood cholesterol,triglycerides after 3-year treatment.The fasting and post-meal insulin level,insulin resistance and the B-cell function index decreased significantly.Meanwhile,the patients with albuminuria and retinopathy increased from 15% and 26% to 23% and 33%.Conclusion Type 2 diabetic patients have not controlled the blood glucose,lipids and the blood pressure satisfactorily even if the agents for the blood sugar,lipids and blood pressure lowing are increased.Insulin resistance decreases but B cell function failure aggravates.The intensified therapy on the target should be paid more attention to.
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Objective The clinical effect of Allitride as disinfectant in infective root canal of deciduous teeth was studied. Methods 40 teeth were put into the cotton thist with Allitride juice in root canals,sealed by zno for a week. FC CP were used in the contrast groups with consist of 38 teeth. Results The effect of 24 teeth in the Allitride group were excellent, 13 teeth were benign, The efficiency was 92 percent. In CP group, 8 teeth were excellent, 5 teeth were benign, The efficiency was 72 percent. 11 excellent effect and 7 benign effect were in FC group. The efficiency was 90 percent. There are significant difference between Allitrade group and GP group(P0.05). The Allitride effect have not significant relation with age, tooth position.Conclusions Allitride is a good disinfectant adapt to infective root canal of deciduous teeth.
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1.4,n=39),Group B(0.90≤ABI≤1.40,n=353)and Group C(ABI1.4 and had higher waist circumference(91.03?7.82)cm vs (87.33?8.93)cmand higher waist/hip ratio(0.95?0.06 vs 0.92?0.06),higher uric acid(273.26?108.10)?mol/L vs (225.06?75.49)?mol/Land CRP(2.60?2.69)mg/L vs(1.76?2.00)mg/Llevel,more smokers(41.0% vs 29.5%)and more hypertension(51.3% vs 35.4%),comparative with those with normal ABI,but no difference except CRP with those ABI 1.40 have more macrovascular risk factors,which is similar with those ABI
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Objective To explore the morbidity rate and risk factors of proliferative diabetic retinopathy (PDR) in type 2 diabetes. Methods The clinical data of patients, with PDR in 2739 consecutive cases of type 2 diabetes diagnosed in this hospital from 1994 to 2001 were analyed retospectively. The diagnosis of diabetic retinopathy (DR) was confirmed by ophthalmoscopy and fundus fluorescein angiography (FFA). Blood pressure, fasting and postprandial blood sugar, glycosylated haemoglobin(HbA1c), total serum cholesterol, triglyceride, creatinine, and albumin excretion rate were measured. Results The morbidity rate of type 2 DR was 27.8%(761/2739), and the morbidity rate of PDR was 4. 2%(114/2 739) occupying 15% of the patients with DR. The duration, fasting blood sugar, glycosylated haemoglobin, blood pressure and albumin excretion rate were much higher than those in the control ( P
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Objective To investigate the factors affecting the clustering of cardiovascular risk factors in Chinese patients with diabetes. Methods Six hundred and fifty four patients with diabetes were examined comprehensively for diabetes complications and cardiovascular risk factors in a metropolitan hospital in Beijing, China. Insulin resistance and secretion were also evaluated by measurement of glucose and insulin levels before and 2h after a meal. Results were analyzed according to patient groups stratified by the number of cardiovascular risk factors coexisting with diabetes. Results Cardiovascular risk factors were common in Chinese diabetic patients. Clustering of three or more of these factors with diabetes occurred greater than that by random one factor alone and was associated with postprandial hyperinsulinemia. Patients with more risk factors were more prone to macrovascular events. Using the commonly adopted lower threshold for diagnosing obesity and central obesity in women, there were more females with multiple risk factors. But the difference disappeared if the same criteria were used for males and females. Even in the presence of diabetes, cardiovascular risk factors were inadequately controlled in most patients. Conclusion The concurrence of diabetes and other cardiovascular risk factors which constitute the metabolic syndrome is a common phenomenon in urban Chinese diabetic patients. It is possibly associated with hyperinsulinemia and gender.
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Objective To investigate the prevalence of lipids disorder in patients with diabetes and the relationship of lipids disorder with sex and hypertension.Methods Totally 2 545 diabetic patients were analyzed for their different lipids disorder based on the clinical data.Results In the group of diabetic patients,1 663 cases were found with lipids disorder (65.3%),and females and males with lipids disorder were 69.6% and 61.9% respectively (P
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Objective To investigate the correlation of the prevalence of periodontitis with age and course of disease in patients with type 2 diabetes.Methods A total of 884 patients with diabetes (both sexes,aged 35-79 yr) were involved in present study.Diagnosis of periodontitis was made according to the 1999 WHO standard,and of type 2 diabetes to the 1997 WHO standard.Age,gender,course of diabetes and periodontal state of those patients were recorded.The patients were grouped according to their age (10 yr interval) and course of disease (5 years interval).Based on the grouping,the collected data were input into ACCESS data bank and statistically analyzed with SAS software,and the prevalence of periodontitis were then compared.Results The prevalence of periodontitis in patients with type 2 diabetes increased with the increasing of age and with the prolonging of disease course (P
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ObjectiveTo investigate the clinical manifestati on and pathogen of hospital acquired low respiratory tract infection in elderly patients with diabetes.MethodsTo analyze retrospectively th e clinical data, the pathogens isolated from cultured sputum and the antibiotic sensitivity of bacteria in 85 elderly patients with diabetes.Results Bacilli in sputum were common in these patients(73 9%), including Pse udomonas aeruginosa (18 2%), Klebsiella pneumoniae(15 9%), Escherichia co li(14.8%), 14% complicated with 2 different bacilli, 6.8% with fungus. The bac illi sensitive rate to antibiotics was as high as 72.3% to Ceftazidime, 70.8% to Ofloxacin, 63 1% to Ceftriaxone, 61 5% to Cefoperazone or Cefoperazone, 60 .0% to Cefazolin, 53.8% to Piperacillin respectively. Cocci sensitive rate wa s 100% to Vancomycin. Uncontrolled hyperglycemia, severe basic diseases and dia betic complications were involved in the pathogenesis of hospital acquired low respiratory tract infection and the poor prognosis.Conclusion Hospital acquired low respiratory tract infection is common in elderly patient s with diabetes, and should be treated based on the antibiotic sensitivity of ba cteria and on metabolic control.
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Diabetic foot ulcers are primarily due to neuropathy and/or ischemia, and frequently complicated by infection. Feet can be stratified for risk of ulceration according to the presence of neuropathy, peripheral vascular disease and deformity. Ulcer can be classified according to the Wagner Classification System to predict prognosis and the risk of amputation. The management of the foot problems differs with neuropathy, peripheral vascular disease, and infections. Prevention is more emphasized than the treatment in decreasing diabetic amputation, particularly in the patients with high risk factors of foot problems.
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The peak plantar pressure and percentage of peak time were evaluated using the Foot scan Plate System in the walking patients without footwear. Diabetic patients with peripheral neuropathy have abnormal plantar pressure distribution, with higher peak plantar pressure in the third and fifth caput of metatarsus and hallux, and longer percentage of peak time.