ABSTRACT
Introducción: Identificar factores de riesgo para pérdida de la sensibilidad protectora es fundamental para prevenir el Pie Diabético. Objetivos: Analizar los factores de riesgo asociados a la pérdida de la sensibilidad protectora en pacientes con diabetes mellitus y sus complicaciones. Materiales y métodos: diseño observacional, de casos y controles. Se incluyó pacientes de ambos sexos, con diabetes mellitus; ≥ 18 años, a quienes se realizó el Test de monofilamento en la Unidad Multidisciplinaria Hospital de Clínicas, de enero 2014 a julio 2019. Factores de riesgo considerados: edad, años de diabetes mellitus, Hba1c, HTA, dislipidemia; se tuvo en cuenta las complicaciones: retinopatía, enfermedad arterial periférica = ITB <0,9 derecho e izquierdo, enfermedad renal= ClCr <60 ml/min/m2 (MDRD), amputaciones (mayores y menores). Resultados: De 100 pacientes; 33% con pérdida de la sensibilidad protectora; edad 59±9,7 años; 55% masculino. Factores de riesgo: edad: 57,7±1,0 años sin pérdida de la sensibilidad protectora y 61,2±9 años con pérdida de la sensibilidad protectora, p=0.08; años de diabetes mellitus 9,4±8,4 vs 11,5± 8,7 p=0,20; HbA1C 8,8± 2,7% vs 9,1±2% p=0,50; HTA 63,5% vs 75,6% p=0,20; dislipidemias 75,9% vs 57,69%, p=0,09; complicaciones con pérdida de la sensibilidad protectora: retinopatía 88% vs 57,5% OR=1,67, p=0,02. ClCr 84±40,3 ml/min vs 90,9±30,4, p=0,40. Enfermedad arterial periférica derecha 27,78% vs 11,1% OR=0,1, p=0,10; enfermedad arterial periférica izquierda 20% vs 7 15,5% OR=1 p=0,60; amputación 17,5% vs 7,9% OR=2,01, p=0,06. Conclusión: con pérdida de la sensibilidad protectora: la edad, años de diabetes mellitus fueron mayores. HTA fue más frecuente y Hba1c más elevada; nefropatía, enfermedad arterial periférica y amputación con mayor frecuencia, todas no significativas. La retinopatía fue más frecuente en forma significativa.
Introduction: Identifying risk factors for loss of protective sensitivity is essential to prevent Diabetic Foot. Objectives: To analyze the risk factors associated with the loss of protective sensitivity in patients with diabetes mellitus and its complications. Materials and methods: observational, case-control design. Patients of both sexes were included, with diabetes mellitus; ≥ 18 years, who underwent the Monofilament Test in the Multidisciplinary Unit Hospital de Clínicas, from January 2014 to July 2019. Risk factors considered: age, years of diabetes mellitus, Hba1c, HT, dyslipidemia; Complications were taken into account: retinopathy, peripheral arterial disease = ABI <0.9 right and left, kidney disease = CrCl <60 ml / min / m2 (MDRD), amputations (major and minor). Results: Of 100 patients; 33% with loss of protective sensitivity; age 59 ± 9.7 years; 55% male. Risk factors: age: 57.7 ± 1.0 years without loss of protective sensitivity and 61.2 ± 9 years with loss of protective sensitivity, p = 0.08; years of diabetes mellitus 9.4 ± 8.4 vs 11.5 ± 8.7 p = 0.20; HbA1C 8.8 ± 2.7% vs 9.1 ± 2% p = 0.50; HTN 63.5% vs 75.6% p = 0.20; dyslipidemias 75.9% vs 57.69%, p = 0.09; complications with loss of protective sensitivity: retinopathy 88% vs 57.5% OR = 1.67, p = 0.02. CrCl 84 ± 40.3 ml / min vs 90.9 ± 30.4, p = 0.40. Right peripheral arterial disease 27.78% vs 11.1% OR = 0.1, p = 0.10; left peripheral arterial disease 20% vs 7 15.5% OR = 1 p = 0.60; 17.5% amputation vs 7.9% OR = 2.01, p = 0.06. Conclusion: with loss of protective sensitivity: age, years of diabetes mellitus were older. HBP was more frequent and Hba1c higher; nephropathy, peripheral arterial disease and amputation with greater frequency, all not significant. Retinopathy was significantly more frequent.
Subject(s)
Diabetic Foot , Diabetes Mellitus , Dyslipidemias , Peripheral Arterial Disease , Amputation, Surgical , Risk Factors , Kidney DiseasesABSTRACT
OBJETIVO: O objetivo deste estudo é avaliar se o método de Semmes-Weinstein tem resultados consistentes e verificar se existem diferenças de sensibilidade entre as regiões da parede abdominal. MÉTODOS: Os monofilamentos de Semmes-Weinstein foram utilizados para avaliar a sensibilidade da pele à pressão abdominal em 20 voluntárias. A pele abdominal foi dividida em nove regiões. A avaliação da sensibilidade cutânea à pressão foi realizada três vezes em cada área, com um intervalo de uma semana entre as medidas. RESULTADOS: Analisando-se as três medidas em cada área, isoladamente, não houve diferenças significativas no limiar pressórico. No entanto, o método de Semmes-Weinstein mostrou diferença estatisticamente significativa entre os valores pressóricos obtidos de cada região abdominal. CONCLUSÕES: Os monofilamentos de Semmes-Weinstein são consistentes para avaliar a sensibilidade da pele abdominal à pressão. Notou-se que o método de Semmes-Weinstein mostrou diferença estatisticamente significativa entre as diferentes áreas da região abdominal. Utilizando-se a metodologia do presente estudo, foi possível estabelecer um protocolo para reduzir o aspecto subjetivo, medindo a sensibilidade à pressão.
OBJECTIVE: The aim of this study is to evaluate whether Semmes-Weinstein monofilaments could be used to reliably assess the sensitivities of different abdominal wall regions. METHODS: Semmes-Weinstein monofilaments were used to evaluate skin sensitivity to abdominal pressure in 20 volunteers. The abdominal skin was divided into nine regions. The assessment of skin sensitivity to pressure was carried out three times in each area, with 1 week intervals between measurements. RESULTS: No significant differences in the pressure threshold were observed when the three measurements in each region were analyzed separately. However, with the Semmes-Weinstein monofilament technique, a statistically significant difference was observed between the values of pressure obtained in each abdominal region. CONCLUSIONS: Semmes-Weinstein monofilaments are a reliable tool in evaluating abdominal skin sensitivity to pressure. A statistically significant difference was observed between the different areas of the abdominal region with this technique. With the method reported in this study, it was possible to establish a protocol to reduce subjectivity and measure the skin sensitivity to pressure.
Subject(s)
Humans , Female , Adult , History, 21st Century , Pressure , Sensory Thresholds , Surgery, Plastic , Comparative Study , Data Interpretation, Statistical , Evaluation Study , Abdominal Wall , Abdomen , Hypesthesia , Pressure/adverse effects , Sensory Thresholds/physiology , Surgery, Plastic/methods , Abdominal Wall/surgery , Abdominal Wall/innervation , Abdomen/surgery , Hypesthesia/surgery , Hypesthesia/diagnosis , Hypesthesia/pathologyABSTRACT
El principal factor desencadenante del pie diabético, complicación más común de la Diabetes Mellitus, es la Neuropatía Diabética (N.D), cuya patogénesis aún es ampliamente discutida. Un método simple, de bajo costo y reproducible para la evaluación de la alteración o ausencia de la sensación protectiva, es la prueba de sensibilidad realizada con los monofilamentos semmes-weinstein (S.W), recomendada como herramienta de tamizaje para la identificación de pacientes diabéticos en riesgo de ulceración. Sin embargo, algunos investigadores discuten su potencial clínico, debido a la falta de estandarización de la técnica de aplicación. Salud UIS 2004; 36:32-39.
The main factor for diabetic foot development, the most frequent complication in Diabetes Mellitus, is Diabetic Neuropathy (D.N), whose specific etiopathology is still unknown. A simple, inexpensive and reproducible method for assessing the sensorial component of D.N, defined as the absence of protective sensation, is the Semmes-Weinstein monofilament kit, which has been repeatedly recommended as a screening tool for identifying diabetic patients with risk of ulceration. However, several researchers discuss its clinical potential, because of the lack of a standardized application technique. Salud UIS 2004; 36:32-39.