Avaliação de rotina do pé diabético em pacientes internados: prevalência de neuropatia e vasculopatia / Routine evaluation of diabetic foot in hospitalized patients: neuropathy and vasculopathy prevalence

O diabetes mellitus (DM) está associado ao desenvolvimento de complicações macroangiopáticas e microangiopáticas. Sugere-se que o pé diabético seja responsável por até 70% das amputações não traumáticas em membros inferiores. O objetivo foi identificar a frequência de alterações vasculares e neurológicas dos pés em pacientes diabéticos internados. Foi realizado um estudo descritivo transversal em hospital universitário de agosto/2015 a agosto/2016. Os pacientes foram submetidos a exame físico detalhado dos pés com avaliação das sensibilidades protetora plantar, vibratória e dolorosa e pesquisa do reflexo aquileu. Também foram colhidos dados socio-demográficos e de presença de comorbidades. Considerou-se portador de neuropatia quem apresentou perda de dois tipos de sensibilidade, e de vasculopatia quem teve claudicação intermitente ou pulsos com diminuição de amplitude. Dos 76 pacientes examinados, 61,8% do sexo feminino, a média de idade foi 60,7 ± 13,5 anos. Destes, 64,4% apresentavam sobrepeso/obesidade (IMC 28,6 ± 6,3). O tempo de diagnóstico do DM foi de 9,5 anos ± 7,6. Associação com tabagismo estava presente em 47,3% dos pacientes, e com etilismo em 38,1% . A comorbidade mais prevalente foi hipertensão arterial sistêmica, em 80,2%. Alteração na avaliação dos pés mais comum foi diminuição de sensibilidade, presente em 69,7% dos pacientes. Redução de pulsos foi encontrada em 34,2%, e 6,5% dos pacientes eram amputados. 13,2% dos indivíduos estudados apresentavam sinais de vasculopatia e neuropatia associadamente ao exame físico. Não houve diferença entre grupos com vasculopatia e neuropatia em relação ao tempo e controle de DM, e frequencia de complicações crônicas. Alta frequência de alterações neurovasculares foi evidenciada, o que reforçou a importância da avaliação periódica dos pés, visando evitar complicações, piora da qualidade de vida e aumento do custo para saúde pública.

Diabetes mellitus (DM) is associated with the development of macroangiopathic and microangiopathic complications. It is suggested the diabetic foot is responsible for up to 70% of the non-traumatic amputations in the lower limbs. We aimed to identify the frequency of vascular and neurological alterations of the feet in hospitalized diabetic patients. A descriptive cross-sectional study was carried out in a university hospital from August/2015 to August/2016. Patients underwent a detailed physical examination of the feet with evaluation of plantar, vibratory and painful protective sensitivities and aquileu reflex. Socio-demographic data and the presence of comorbidities were also collected. It was considered neuropathy loss of two types of sensitivities, and vasculopathy intermittent claudication and nonpalpable pulses. From 76 patients examined (61.8% female), mean age was 60.7 ± 13.5 years. 49 patients (64.4%) were overweight / obese (BMI 28.6 ± 6.3). The time of DM diagnosis was 9.5 years ± 7.6. 47,3% subjects presented the association with smoking and 38,1% with alcoholism. The most prevalent comorbidity was systemic arterial hypertension(80.2%). The most common change in the assessment of foot was sensitivity reduction, present in 69.7% of patients. Reduction of pulses was found in 34.2%, and 6.5% of the patients had undergone before amputation. 13,2% os the subjects had simultaneous signs of vasculopathy and neuropathy. There was no difference between groups with and without physical examination changes in relation to the time and control of DM, and the frequency of chronic complications. We showed a high frequency of neurovascular changes, which reinforced the importance periodic assessment of feet, aim at avoiding complications which worsen quality of life and increasing public health costs.

Approach to the patients of diabetic foot disease with refractory ulcers - Report of 4 typical cases with therapeutic experiences / 中华内分泌代谢杂志

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.

Surgical Treatment of Diabetic Foot Disease / 임상당뇨병

Diabetic foot diseases which require surgical treatment consists of diabetic foot ulcer, infection and neuropathic arthropathy. Surgical procedures for diabetic foot ulcers and infections such as drainage, debridement, partial foot amputation and major limb amputation are most common procedures and arthodesis with or without deformity correction can be performed for specific diabetic neuropathic arthropathies. Underlying pathomechanism of diabetic foot disease includes diabetic peripheral neuropathy and vasculopathy. Treating physicians should be aware that concomitant complications of long-standing diabetic status such as cardiovascular and renal dysfunction should be addressed to treat intractable diabetic foot diseases successfully. However, with advent of adjuvant treatment which increases vascular supply on ischemic limb disease, proper surgical treatment on diabetic foot disease can prevent or delay major limb amputations, sustaining functional capability of diabetic patients.