Early diagnosis of diabetic neuropathy and prophylaxis of diabetic foot / Diagnóstico precoce da neuropatia diabética e profilaxia do pé diabético

Introduction: the diabetic foot is one of the most serious complications of diabetes mellitus. About 50% of non-traumatic amputations occur in these patients. In addition, it is an important public health problem and constitutes a chronic and complex metabolic disorder that is characterized by impaired metabolism of glucose and other complications in essential organs for the maintenance of life. Objective: to evaluate the sensitivity and specificity of diabetic neuropathy using the Michigan self-assessment and physical examination in type 1 and type 2 diabetics. Methods: this is a cross-sectional study. The "Michigan Neuropathy Screening Instruments" classification was used to assess the degree of peripheral neuropathy, in which participants answered the questionnaire and were evaluated for the presence of foot lesions. All participants were stratified by the risk of developing foot ulcers according to the IWGDF protocol. Results: the sample had 200 participants. Regarding the IWGDF classification, 23 patients were classified as moderate risk (11.50%) and 61 as high risk for developing foot ulcers (30.50%). Using a cutoff of 2.5 on the physical examination score to diagnose neuropathy, a sensitivity of 97.62% and a specificity of 47.41% were obtained. Using a score greater than or equal to 6 in the self-assessment for the diagnosis of neuropathy, a sensitivity of 50.00% and a specificity of 94.83% were found. Conclusion: the association of the Michigan physical examination (high sensitivity) with self-assessment (high specificity) increases the accuracy for the diagnosis of diabetic neuropathy

Introdução: o pé diabético é uma das complicações mais sérias do diabetes mellitus. Cerca de 50% das amputações não traumáticas ocorrem nesses pacientes. Além disso, é um importante problema de saúde pública por ser um distúrbio metabólico crônico e complexo que se caracteriza pelo comprometimento do metabolismo da glicose associada a outras complicações em órgãos essenciais para manutenção vital. Objetivo: avaliar a sensibilidade e especificidade para neuropatia diabética da autoavaliação e do exame físico de Michigan nos diabéticos tipo 1 e tipo 2. Método: trata-se de um estudo transversal. Foi utilizada a classificação "Michigan Neuropathy Screening Instruments" para avaliação do grau de neuropatia periférica, em que os participantes responderam ao questionário e foram avaliados quanto a presença de lesões nos pés. Todos os participantes foram estratificados quanto ao risco de desenvolver úlcera nos pés de acordo com o protocolo do IWGDF. Resultados: a amostra contou com 200 participantes. Quanto à classificação do IWGDF, 23 pacientes foram classificados como risco moderado (11,50%) e 61 como alto risco para o desenvolvimento de úlceras nos pés (30,50%). Utilizando-se um corte de 2,5 na pontuação do exame físico para diagnosticar a neuropatia, foi obtida uma sensibilidade de 97,62% e uma especificidade de 47,41%. Utilizando-se uma pontuação maior ou igual a 6 na autoavaliação para o diagnóstico de neuropatia, foi obtida uma sensibilidade de 50,00% e uma especificidade de 94,83%. Conclusão: a associação do exame físico de Michigan (alta sensibilidade) com a autoavaliação (alta especificidade) tem melhor acurácia para o diagnóstico de neuropatia diabética.

Correlación entre pie diabético y retinopatía diabética en pacientes del hospital provincial de Zaire, Angola

Introducción: La diabetes mellitus produce complicaciones, dentro de las cuales se describen la neuropatía diabética y la angiopatía diabética, que en presencia de estas puede llegarse a un cuadro de pie diabético sin dejar de mencionar la pérdida visual por retinopatía diabética. Objetivo: Determinar la correlación existente entre la aparición de pie diabético y la presencia o no de la retinopatía diabética en pacientes del Hospital Provincial "María Eugenia Neto", Zaire, República de Angola, en el período comprendido entre septiembre de 2020 a septiembre de 2022. Método: Se realizó un estudio descriptivo en 181 pacientes de la consulta de pie diabético del hospital antes dicho, donde se describieron variables, tales como: edad, sexo, enfermedades crónicas asociadas, presencia o no de retinopatía diabética, úlceras en miembros inferiores, amputación en miembros inferiores y años con diabetes. Se realizaron pruebas de correlación bivariable, se analizó el coeficiente de correlación de Pearson. Resultados: El promedio de edad fue de 59,3 años, predominó el grupo etario de más de 70 años (28,2 %) y el sexo femenino (57,5 %). Presentaron amputaciones previas un 41,8 % y úlceras un 40,1 %. Sin tratamiento estable el 65,19 %, correlación estadísticamente fuerte y significativa entre pie diabético y la retinopatía diabética. Conclusiones: Se evidencia una fuerte y significativa relación existente entre los pacientes portadores de pie diabético, los cuales pueden padecer determinado grado de retinopatía diabética, más frecuentes en el sexo femenino después de la sexta década de la vida, con los cuales presentan mayor tiempo de evolución de su enfermedad.

Introduction: Diabetes mellitus leads to many associated complications, including diabetic neuropathy and diabetic angiopathy, both with a high incidence in the onset diabetic foot and including also the diabetic retinopathy disease cause of blindness. Objective: Determine if there is any correlation between the onset diabetes foot and whether or not diabetic retinopathy present in patients treated at the Hospital Provincial, María Eugenia Neto, Zaire, Republic of Angola, from September 2020 to September 2020. Method: A descriptive study was carried out in 181 patients treated in the diabetic foot department of the aforementioned hospital; variables described were as follow: age, sex, associated chronic diseases, presence or absence of diabetic retinopathy, lower limb ulcers, limb amputation and years with diabetes. Bivariate correlation tests were performed, and the Pearson´s correlation coefficient was analyzed. Results: The average age was 59.3 years, the age group over 70 years (28.2%) and the female sex (57.5%) predominated. The 41.8% of patients presented previous amputations and 40.1% had ulcers. The 65.19% of patients had irregular treatment patterns, statistically strong and significant correlation between diabetic foot and diabetic retinopathy. Conclusions: There is evidence of a strong and significant relationship between patients with diabetic foot, who may suffer from a certain degree of diabetic retinopathy, more frequent in females after their sixth decade of life that cause a longer evolution of his disease.

Introdução: O diabetes mellitus produz complicações, dentre as quais são descritas a neuropatia diabética e a angiopatia diabética, que na presença destas podem levar ao quadro de pé diabético, sem falar na perda visual pela retinopatia diabética. Objectivo: Determinar a correlação existente entre o aparecimento de pé diabético e a presença ou ausência de retinopatia diabética em doentes do Hospital Provincial "María Eugenia Neto", Zaire, República de Angola, no período de setembro de 2020 a setembro de 2022. Método: Estudo descritivo realizado em 181 pacientes do ambulatório de pé diabético do referido hospital, onde foram descritas variáveis como: idade, sexo, doenças crônicas associadas, presença ou ausência de retinopatia diabética, úlceras de membros inferiores, amputação de membros inferiores e anos com diabetes. Foram realizados testes de correlação bivariada e analisado o coeficiente de correlação de Pearson. Resultados: A média de idade foi de 59,3 anos, predominando a faixa etária acima de 70 anos (28,2%) e o sexo feminino (57,5%). 41,8% tinham amputações anteriores e 40,1% tinham úlceras. Sem tratamento estável 65,19%, correlação estatisticamente forte e significativa entre pé diabético e retinopatia diabética. Conclusões: Existe evidência de uma relação forte e significativa entre os doentes com pé diabético, que podem sofrer de um certo grau de retinopatia diabética, mais frequente no sexo feminino a partir da sexta década de vida, com os quais apresentam maior evolução da sua doença.

Maduración pulmonar fetal en diabetes mellitus pregestacional y complicaciones crónicas / Fetal lung maturation in pregestational diabetes mellitus and chronic complications

Las pacientes embarazadas con diabetes mellitus (DM) pregestacional y complicaciones micro y macroangiopáticas tienen mayor riesgo de empeoramiento de las mismas y de presentar otros trastornos asociados al embarazo. La progresión de la retinopatía diabética ocurre durante el embarazo y el posparto. La nefropatía se asocia con un mayor riesgo de preeclampsia, parto prematuro, restricción del crecimiento fetal y mortalidad perinatal. Cuando hay enfermedad de arterias coronarias o gastroparesia se observa un aumento de la morbilidad materna y fetal. El parto prematuro es una condición prevalente en pacientes con DM. La maduración pulmonar fetal con corticosteroides fue extensamente estudiada, con numerosas pruebas controladas, hasta convertirse en una de las más importantes terapias prenatales basadas en evidencias para reducir la mortalidad perinatal y el síndrome de dificultad respiratoria, la hemorragia intraventricular y la enterocolitis necrosante en los niños prematuros. Sin embargo, en dicha evidencia no se han incluido a embarazadas con DM, por lo cual no se conocen resultados perinatales en este grupo de pacientes.

Pregnant patients with pregestational diabetes mellitus (DM) and micro and macroangiopathic complications have a higher risk of their worsening and of presenting other pregnancyassociated disorders. The progression of diabetic retinopathy occurs during pregnancy and postpartum. Nephropathy is associated with an increased risk of preeclampsia, preterm delivery, fetal growth restriction, and perinatal mortality. When there is coronary artery disease or gastroparesis, an increase in maternal and fetal morbidity is observed Preterm delivery is a prevalent condition in diabetic patients. Corticosteroid fetal lung maturation has been extensively studied, with numerous controlled trials, to become one of the most important evidence-based prenatal therapies to reduce perinatal mortality and decrease respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis, in premature infants. Nevertheless, this evidence did not include patients with DM, for this reason perinatal results are not known in this group of patients.

Maduración pulmonar fetal en diabetes mellitus pregestacional y complicaciones crónicas / Fetal lung maturation in pregestational diabetes mellitus and chronic complications

Resumen Las pacientes embarazadas con diabetes mellitus (DM) pregestacional y complicaciones micro y macroangiopáticas tienen mayor riesgo de empeoramiento de las mismas y de presentar otros trastornos asociados al embarazo. La progresión de la retinopatía diabética ocurre durante el embarazo y el posparto. La nefropatía se asocia con un mayor riesgo de preeclampsia, parto prematuro, restricción del crecimiento fetal y mortalidad perinatal. Cuando hay enfermedad de arterias coronarias o gastroparesia se observa un aumento de la morbilidad materna y fetal. El parto prematuro es una condición prevalente en pacientes con DM. La maduración pulmonar fetal con corticosteroides fue extensamente estudiada, con numerosas pruebas controladas, hasta convertirse en una de las más importantes terapias prenatales basadas en evidencias para reducir la mortalidad perinatal y el síndrome de dificultad respiratoria, la hemorragia intraventricular y la enterocolitis necrosante en los niños prematuros. Sin embargo, en dicha evidencia no se han incluido a embarazadas con DM, por lo cual no se conocen resultados perinatales en este grupo de pacientes.

Abstract Pregnant patients with pregestational diabetes mellitus (DM) and micro and macroangiopathic complications have a higher risk of their worsening and of presenting other pregnancyassociated disorders. The progression of diabetic retinopathy occurs during pregnancy and postpartum. Nephropathy is associated with an increased risk of preeclampsia, preterm delivery, fetal growth restriction, and perinatal mortality. When there is coronary artery disease or gastroparesis, an increase in maternal and fetal morbidity is observed Preterm delivery is a prevalent condition in diabetic patients. Corticosteroid fetal lung maturation has been extensively studied, with numerous controlled trials, to become one of the most important evidence-based prenatal therapies to reduce perinatal mortality and decrease respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis, in premature infants. Nevertheless, this evidence did not include patients with DM, for this reason perinatal results are not known in this group of patients.

Evaluación oftalmológica de pacientes con úlcera de pie diabético / Ophthalmologic evaluation of patients with diabetic foot ulcer

Introducción: La prevalencia de diabetes aumenta paulatinamente a nivel mundial y con ello, se incrementa el riesgo de complicaciones microvasculares como la retinopatía diabética. El riesgo de ceguera se reduce con control metabólico estable, diagnóstico temprano y tratamiento adecuado. Objetivo: Comparar el resultado del examen oftalmológico realizado antes de iniciar el tratamiento con Heberprot-P, con el realizado a los cinco meses de iniciado, a diferentes dosis. Métodos: Se realizó un estudio observacional, retrospectivo, en 77 pacientes incluidos en cuatro ensayos clínicos de Heberprot-P. Se realizó análisis de las variables examen oftalmológico antes y después del tratamiento, tipo de diabetes y años de evolución. Resultados: Se observó predominio de los diabéticos tipo 2 respecto a los tipo 1 en una razón 11:1, con una media de 16,3 años de evolución de la diabetes. La mitad de los pacientes tenían retinopatía diabética no proliferativa, con predominio de la forma leve, en el examen realizado antes del tratamiento con Heberprot-P. Solo un paciente anciano con otras comorbilidades, desarrolló una retinopatía diabética proliferativa, luego de un examen previo en que se observó retinopatía diabética no proliferativa y edema macular diabético. Conclusiones: La aparición o progresión de retinopatía diabética es infrecuente en pacientes complicados con úlcera del pie diabético tratados con Heberprot-P, hasta cinco meses después de tratamiento(AU)

Introduction: The prevalence of diabetes gradually increases worldwide and with it, the risk of microvascular complications such as diabetic retinopathy. The risk of blindness is reduced with stable metabolic control, early diagnosis and adequate treatment. Objective: To compare the result of the ophthalmological examination performed before starting treatment with Heberprot-P, with that performed five months after initiation, at different doses. Methods: A retrospective observational study was conducted in 77 patients included in four clinical trials of Heberprot-P. Analysis of the ophthalmological examination variables before and after treatment, type of diabetes and years of evolution were performed. Results: Prevalence of type 2 diabetics was observed with respect to type 1 in an 11: 1 ratio, with an average of 16.3 years of diabetes evolution. Half of the patients had nonproliferative diabetic retinopathy, predominantly of the mild form, in the examination performed before treatment with Heberprot-P. Only one elderly patient with other comorbidities developed a proliferative diabetic retinopathy, after a previous examination in which non-proliferative diabetic retinopathy and diabetic macular edema were observed. Conclusions: The appearance or progression of diabetic retinopathy is uncommon in complicated patients with diabetic foot ulcer treated with Heberprot-P, up to five months after treatment(AU)

Factores de riesgo asociados al pie diabético

Introducción: El pie diabético representa una de las causas de mayor morbilidad e incapacidad en las personas con Diabetes Mellitus. Esta población abarca hasta el 70% de las amputaciones, en su mayoría desencadenada por la infección. La vasculopatía periférica, la neuropatía periférica asociadas al control metabólico juegan un rol importante en su génesis. El conocimiento de los mismos en la atención primaria asociadas a las medidas de prevención colaborarán en la disminución de este flagelo que aqueja a millones en la actualidad. Objetivos: Determinar los factores de riesgo asociados a las lesiones del pie diabético. Describir las características demográficas y clínicas de los pacientes con lesiones del pie diabético. Material y métodos: estudio de casos y controles. No probabilístico, de casos consecutivos. Se incluyeron pacientes adultos internados en el Departamento de Medicina Interna durante el 2015, diabéticos, con y sin lesiones en pie, sin amputaciones previas e independientes del tratamiento farmacológico. Resultados: se incluyeron 86 sujetos, de los cuales 59% de los casos presentaron onicomicosis, el 57% neuropatía, el 67% vasculopatía, 45% algún tipo de deformidad y un 63% utilizaban calzados inadecuados. Conclusiones: La onicomicosis representó un factor de riesgo significativo para el desarrollo del pie diabético (p=0,02). En lo que respecta a la vasculopatía, la neuropatía y el control glicémico no se pudo establecer un riesgo significativo.

Introduction: The diabetic foot is one of the main causes of higher morbidity and disability in people with Diabetes Mellitus. This population comprises up to 70% of amputations, mostly triggered by infections. The peripheral vascular disease and the peripheral neuropathy associated with metabolic control play an important role in its genesis. The knowledge about them associated with prevention measures in primary care contribute to reduce this scourge that currently afflicts millions. Objectives: To determine risk factors associated with diabetic food lesions and to describe the demographic and clinical characteristics of patients with diabetic foot lesions. Material and methods: Case-control study with non-probabilistic consecutive sampling. Adult diabetic patients with and without foot lesions, without previous amputations, independent of pharmacological treatment and admitted into the Department of Internal Medicine during 2015 were included. Results: 86 subjects were included, 59% of the cases had onychomycosis, 57% neuropathy, 67% vasculopathy, 45% some deformity and 63% used inadequate footwear. Conclusions: Onychomycosis represented a significant risk factor for the development of diabetic foot (p = 0.02). Concerning vasculopathy, neuropathy and glycemic control, a significant risk could not be established.