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The China International Exchange and Promotion Association for Medical and Healthcare ( CPAM) , Diabetic foot branch, published the Guideline for the Diagnosis and Management of Diabetic Foot in July 2017, which provides recommendations for the screening of the patients at risk of diabetic foot, diag-nosis, treatment, and effective prevention of diabetic foot. In this article, we provided a professional inter-pretation and comment on the basis of the guideline as follows: ⑴ The prevention of diabetic foot should give priority to early recognition of the at-risk foot, especially early screening and treatment of diabetic pe-ripheral neuropathy and lower extremity arterial disease;⑵The treatment of diabetic foot ulcers should take multidisciplinary cooperative therapy, including off-loading, debridement, anti-infective therapy, and im-proving blood supplement if necessary;⑶ Ultimately, the goal of treatment is to prevent the cardiovascular and cerebrovascular events, and reduce amputation rate, disability rate and mortality.
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Objective To explore the optimal protocol of lower-extremity contrast-enhanced MRA (CE-MRA) in the evaluation of diabetic foot.Methods Twenty eight healthy volunteers were scanned by CE-MRA in crus twice with parellel imaging factor (PIF) of 3 or 4.The signal-to-noise ratio (SNR),contrast-to-noise ratio (CNR) and image quality of popliteal artery,posterior tibial artery,anterior tibial artery and peroneal artery were compared.Twenty patients with diabetic foot underwent CE-MRA by both of protocol 1 and 2 in leg,crus and foot.Protocol 1 was the traditional Care-bolus protocol and protocol 2 was the optimized K-space center filling delay-time protocol.The difference of two protocols in venous aliasing and in display of femoral artery,popliteal artery,posterior tibial artery,anterior tibial artery,peroneal artery,dorsalis pedis artery,medial plantar artery and lateral plantar artery were compared.The SNR,CNR of two different PIF sequences were compared by paired t test,and the display of artery of crus was compared by Wilcoxon.The display of vessels and venous aliasing of 2 protocols of diabetic foot patients were compared by Wilcoxon.Results In the images of healthy volunteers with PIF of 3,the SNR were 267±84,174±51,147±42;and the CNR were 232 ±83,139±51,108±39 at popliteal artery,posterior tibial artery and peroneal artery.However,in the images with PIF of 4,the SNR were 239±73,157±53,132±35;and CNR were 206±71,124±50,103±33,respectively.Both the SNR and CNR were higher in the former than in the latter(t values were 2.31 to 4.11,P＜0.05).There was no significant difference in the vessel display between the different PIF volunteers (P＞0.05).In the protocol 1 of patients with diabetic foot,the display of popliteal artery,posterior tibial artery,anterior tibial artery,peroneal artery,dorsalis pedis artery,medial plantar artery and lateral plantar artery,the venous aliasing in crus and foot were 3.40±0.82,2.70±0.80,2.50±1.00,2.20±0.77,2.30±0.92,2.15± 1.04,1.45±0.60,2.20± 1.01,2.20± 1.06.And in the protocol 2,they were 3.85±0.37,3.55± 0.69,3.30±0.92,2.90±0.79,3.30±0.92,3.25±0.79,1.95±1.10,3.70±0.47,3.65±0.49,respectively(P＜0.05).All of these parameters of protocol 2 were superior to protocol 1.Conclusion Using a higher PIF properly,setting the personalized K-space center filling delay-time can contribute to improving the image quality of whole lower-extremity MRA in patients with diabetic foot.
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This investigation was directed to the metabolic syndrome and the islet beta-cell secretory function in the first-degree relatives (FDR) of type 2 diabetic patients in Sichuan province. A large cohort study was designed. Totally 1929 subjects were investigated. They were in two groups: FDR group comprising 505 first-degree relatives of type 2 diabetic patients, and Control group comprising 1424 controls without positive family history of Diabetes. Blood pressure, weight, waist, plasma glucose, lipids and insulin were measured. HOMA-IR and HOMA-beta indexes were used to evaluate insulin resistance and beta-cell secretion function. The insulin sensitivity index (ISI) and glucose disposition index (DI) were also used to evaluate insulin resistance. After adjustment for age and sex, HOMA-IR increased, ISI, DI and HOMA-beta decreased in FDR group when compared with controls (P < 0.05). The incidence of co-existed three or more metabolic disorders and metabolic syndrome was higher in FDR group than that in control group (P < 0.05). In FDR group, HOMA-IR increased, HOMA-beta, DI and ISI decreased while the number of co-existing metabolic disorders increased. But when the number of co-existing metabolic disorders > or = 4, HOMA-IR increased no longer and ISI decreased no more. Metabolic disorders occurred more frequently in FDR of diabetic patients than those in individuals without positive family history. As the number of co-existing metabolic disorders increased, the beta-cell secretion function and insulin sensitivity became worse. Our study indicated that it is necessary to keep on monitoring the metabolic index in FDR of type 2 diabetes and provide early preventive interventions.
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , China , Epidemiologia , Estudos de Coortes , Diabetes Mellitus Tipo 2 , Genética , Teste de Tolerância a Glucose , Resistência à Insulina , Ilhotas Pancreáticas , Síndrome Metabólica , Epidemiologia , Genética , Inquéritos e QuestionáriosRESUMO
Objective To compare the safety and effectiveness between treatments with autologous platelet gel (APG) versus standard care for treating refractory diabetic dermal ulcers.Methods The 46 patients with proved nonhealing diabetic dermal ulcers were enrolled. Eligible for the study were patients with grade II/III ulcers according to Wagner, lasting for at least 2 weeks and with no signs of infection at recruitment.Patients were given their informed consent document and randomly assigned to two groups: standard care (ST, n=23) or standard care plus topic application of APG (APG, n=23) for twelve weeks.The treatment of blood glucose, blood pressure and lipids was optimized and the empiric antibiotic treatment was further adjusted according to the results of culture and sensitivity testing in all patients. APG treatment consisted of wound dressing with APG, followed by topical washing and cleaning. The APG was then covered with vaseline gauze for 72 hours, after which the ulcers were treated by standard care. Participants were seen thrice a week, twice a week, or at weekly intervals. Twelve weeks observation was set as the end point.Results The would of APG group were improved in 22 patients with ulcers healed completely and 1 case with would area reduced. In the ST group, 13 ulcers were healed, 6 worsened and 4 with would area reduced. The cumulative rate of ulcer healing was 95.7% in the APG group versus 56.5% in the ST group (P=0.002). The total effective rate in APG vs ST group was 100.0% vs 73.9% (P=0.009). By Kaplan-Meier analysis,the time-to-healing of ulcer and time-to-lutation of sinus were significantly different between two groups (log-rank, P=0.006, 0.000, respectively). No treatment-related adverse events were observed. Conclusions Treatment with APG in addition to standard care results in a significantly faster and better healing for a refractory diabetic dermal ulcer and does not raise any safety concerns. So APG treatment can be a valuable and effective aid in the management of diabetic foot ulcers.
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Objective To investigate the prevalence of diabetic foot(DF) in the hospitalized diabetic patients and analyze the clinical characteristics and therapeutic efficacy of patients with diabetic foot. Methods The 313 patients (180 males and 133 females) were divided into two groups：group A (1/1996-12/2003) and group B (1/2004-12/2006). Results 2.79% of the hospitalized diabetic patients had diabetic foot. The mean age and duration of diabetes were 66±10 years old and 9.33±6.52 years respectively, the mean duration of diabetic foot was 8.13±17.06 months and the average days in hospital was 29.62±28.36d. Many patients suffered from diabetic nephropathy, cataracts, retinopathy, neuropathy, vascular disease, hypertension, infection, and so on. The blood pressure and blood glucose were poorly controlled in many of the patients. Of all patients, 28.1% were completely healed, 40.6% were improved without amputation and 31.3% had not healed at the time of death or follow-up (including 9.3 % of them were amputated in leg and 6.2% were dead). But group B versus group A showed higher cure rates of DF (37.04 % vs 18.54 %). Conclusions The prevalence of DF in the hospitalized diabetic patients is gradually increased, most patients with DF accompany with one or multiple other complications. A multifactorial treatment by a multidisciplinary foot care team is a superior treatment strategy for improving prognosis of patients with DF.
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Objective To set up the reference value of serum glyeated albumin (CA) in Chinese for using in clinical practice through a multi-center clinical trial. Methods Three hundred and eighty individuals with normal weight and normal glucose regulation, including 183 males and 197 females ranging from 20 to 69 years, were recruited from 10 hospitals in China. Serum GA levels were measured with liquid enzymatic method. Results (1) The GA level of the 380 subjects was (14. 5±1.9)%. When dividing these subjects by age into 3 subgroups, there was no difference in the GA levels among the 3 subgroups (P>0.05). Compared with the women, the men had higher GA level in the first subgroup aging from 20 to 39 (P =0.028). However, no significant difference was detected after adjusting with BMI as confounder.(2) When dividing those subjects by BMI into 3 subgroups, with BMI ranging from 18. 5-20. 9 kg/m2,21.0-22. 9 kg/m<'2>and 23.0-24. 9 kg/m<'2>respectively, we came to the following results: for men, there was no difference in the GA levels among the 3 subgroups (P>0.05), but for women, the GA level of the first subgroup was higher than that of the second subgroup (P =0.024). (3) The level of GA in the 2. 5th to 97.5th percentile was 10. 8%-17. 1%. (4) Sixty normal subjects were chosen to repeat evaluation of GA levels after 2-3 weeks and the GA levels were of no difference (P>0.05).Conclusion The normal range of serum GA for the Chinese population could be suggested at 11%-17%.
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The alterations in atherogenic index of plasma (AlP) in type 2 diabetic patients and their normoglycemic first-degree relatives (NFDR) were investigated, and the effects of Acarbose or Glimepiride on AIP in 99 type 2 diabetic patients were evaluated. Triglycerride (TG), total cholesterol, high density lipoprotein-cholesterol (HDL-C) levels were analyzed, and Log (TG/HDL-C) was calculated as AIP in 62 type 2 diabetic patients and their 67 NFDR from 29 type 2 diabetic pedigrees and in 45 healthy controls without family histories of diabetes. Also analyzed were the same parameters in 99 type 2 diabetic patients before and after therapy with Acarbose or Glimepiride. The results revealed that diabetic patients and their NFDR had significantly higher AIP than did the controls, whereas no significant differences were seen between diabetic patients and their NFDR. Positive correlation of AIP between type 2 diabetic patients and their offspring were observed (r = 0.241, P < 0.05). After 8 weeks therapy with Acarbose, the AIP of type 2 diabetic patients was decreased significantly, and no differences were observed for AIP levels in Glimepiride group although the AIP was lower when compared with the untreated level. As a significant inverse correlation of small dense low density lipoprotein (sdLDL) with AIP was confirmed, our data suggest that diabetic patients and their NFDR from type 2 diabetic pedigrees had significantly higher AIP than did controls; AIP could be decreased by therapy with Acarbose in type 2 diabetic patients; Glimepiride may bring potential benefit to type 2 diabetic patients by influencing sdLDL.
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Humanos , Acarbose , Usos Terapêuticos , Aterosclerose , Sangue , Índice de Massa Corporal , Estudos de Casos e Controles , HDL-Colesterol , Sangue , Diabetes Mellitus Tipo 2 , Sangue , Tratamento Farmacológico , Hipoglicemiantes , Usos Terapêuticos , Linhagem , Compostos de Sulfonilureia , Usos Terapêuticos , Triglicerídeos , SangueRESUMO
Recently some studies have showed that bone strength may avoid the misdiagnosis and missed diagnosis of osteoporosis(OP) by bone mineral density (BMD) alone. It was found that corrected bone mineral content (cBMC) was well correlated with bone strength. In this study bone strength was replaced by cBMC to compare it with BMD, and evaluate whether BMD has limitations in the diagnosis of OP in obese individuals. one hundred and two healthy subjects in the community with the body mass index (BMI) between 25 and 39 kg/m2 were enrolled. There were 31 males and 71 females with a mean age of 37.2 +/- 9.4 years. Their BMD and BMC of lower limbs, trunk and the whole body were measured with dual energy X-ray absorptiometry (DEXA). cBMC was expressed by BMC divided by weight. Intra abdominal fat area (IAFA) was measured by CT scan at the level between 4th-5th lumbar vertebra. Linear correlation analysis with SPSS 10.0 soft pack was used for statistics. The results showed that there was a positive correlation and tendency between body weight, BMI and BMD values of lower limbs, trunk and the whole body. However, negative correlation and tendency were demonstrated between body weight, BMI and cBMC, between IAFA and BMD of lower limbs, trunk and the whole body and between IAFA and cBMC as well. We found that the tendency of changes of cBMC and bone strength was similar. So we suggest in certain extent that cBMC could replace bone strength in the diagnosis of OP in obese individuals.
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Abdome , Tecido Adiposo , Densidade Óssea , Osso e Ossos , Fisiologia , Obesidade , Osteoporose , DiagnósticoRESUMO
Objective To study the CT features of cerebral infarction and the relation to blood glucose level in diabetes mellitus.Methods The CT features and relation to the level of blood glucose were retrosepectively analyzed in 41 cases of cerebral infarction diabetes mellitus.The diagnosis of diabetes mellitus was based on the WHO criteria in all cases.Results The focus of infarction located at the area of base ganglion,brain stem and thalamencephalon in 38 cases(92.7%).Multiple focus was found in 30 cases(73.2%)and there was positive correlation between focus number and the level of blood glucose.Lacuna cerebral infarction was observed in 38 cases(92.7%) and large patchy cerebral infarction in 3 cases.Brain white matter demyelination was complicated in 24 caese(58.5%).Conclusion Cerebral infarction of diabetes mellitus mainly manifestes as multiple lacuna cerebral infarction and has close relation to the level of blood glucose.