RESUMO
Background: Diabetes mellitus is as old as mankind and perhaps humans know it from early ages. It is one of the most deeply studied diseases and is still un-understandable ailment that humans deal with. As we are digging deeper into the molecular basis of the disease, mind boggling results are coming out. It is not a single disease but a constellation of diseases that it gives birth to i.e. the complications. The main aim of this study was to evaluate the ultimate outcome of patients who present with lower limb complications related to diabetes mellitus type – 2 by early surgical intervention and to prevent infections to establish and become deep seated and involve deeper structures like muscles, bones or joints and to minimize the chances of amputation by early intervention. This study was carried out in Maharaja Agrasen Medical College, Agroha, Hisar, Haryana, India. Material and methods: The present prospective study was carried out on 150 patients who were suffering from foot ulcers in type – 2 diabetes mellitus and were randomly selected. The selected patients were evaluated for the presence of complications like peripheral vascular disease, and Umesh Kumar Chhabra, Sandeep Kumar Goyal, Satish Kumar Bansal, Gopal Singal. Diabetic foot – A clinical study: Early surgical intervention is a key to early cure and rehabilitation in accordance with the international consensus on the Diabetic foot. IAIM, 2016; 3(1): 110-115. Page 111 neuropathy. The ulcers were swabbed, cultured and early surgical intervention was done after which wounds were dressed with either of the following: Saline gauze, Povidone-iodine, Hydrogel, Hydrocolloid base, Human Recombinant Platelet derived Growth Factor. Results: 150 patients (100%) required early debridement, 83 patients (55.33%) required Split Skin Grafting, 5 patients (3.33%) required flap, 38 patients (25.33%) did not require any further surgical treatment and their wounds healed with dressing alone, 24 patients (16%) required amputation. Conclusions: Patient characteristics, such as sex, age, poor glycemic control, presence of peripheral vascular disease, peripheral neuropathy and delayed surgical intervention have a poor outcome in form of complete wound healing in patients with Diabetic foot.
RESUMO
Las Enfermedades Periodontales afectan de forma adversa el control metabólico de Diabetes Mellitus. Se postula que si un paciente diabético mantiene salud periodontal a través del tratamiento periodontal no quirúrgico puede mejorar el control glucémico. Por lo tanto el identificar pacientes con enfermedad periodontal avanzada puede ser un elemento clínico relevante para sospechar de diabetes no diagnosticada y su tratamiento puede tener un efecto positivo en el control metabólico de la diabetes, medido a través de los niveles de hemoglobina glucosilada (HbA1c). En el primer caso se da seguimiento a un paciente con Diabetes Mellitus tipo 1 y en el segundo reporte clínico a un paciente con Diabetes Mellitus tipo 2, con el objetivo de observar si el tratamiento periodontal mejora el control glucémico. Después del tratamiento periodontal no quirúrgico, en ambos casos clínicos existió disminución de hemoglobina glucosilada (HbA1c) teniendo un efecto positivo el tratamiento periodontal en el control metabólico medido a través de los niveles de hemoglobina glucosilada (HbA1c).
Periodontal Diseases affect Diabetes Mellitus metabolic control adversely. It is stated that if a diabetic patient keeps his/her periodontal health by means of a non-surgical periodontal treatment, his/her glycemic control can improve. Therefore, to identify patients with advanced periodontal diseases it can be a relevant clinical element to suspect a non-diagnosed diabetes and its treatment can have a positive effect on the diabetes metabolic control, measured through glycosylated hemoglobin levels (HbA1c). In the first case, a patient with Diabetes Mellitus type 1 is followed up, and in the second clinical report a patient with Diabetes Mellitus type 2 was followed up with the purpose of observing whether the periodontal treatment improves glycemic control. After the non-surgical periodontal treatment, there was a glycosylated hemoglobin decrease (HbA1c), with periodontal treatment having a positive effect on the metabolic control measured through glycosylated hemoglobin levels (HbA1c).
RESUMO
OBJECTIVE: This study was performed to determine the relations of glycosylated hemoglobin (HbA1c) and parameters of nerve conduction study (NCS) in diabetic peripheral polyneuropathy patients. METHOD: Prospectively, total 40 patients with non-insulin dependent diabetes mellitus were included in the study. NCS was performed on median, ulnar, posterior tibial, deep peroneal, superficial peroneal, and sural nerves. Distal latency and conduction velocity (CV) of compound muscle action potential (CMAP), distal latency and amplitude of sensory nerve action potential (SNAP) were used as parameters of NCS. Multiple linear regression analysis were used to analyze the relations of HbA1c and parameters of NCS, after adjustment for age, height, weight, and disease duration of diabetes mellitus. RESULTS: HbA1c level had an inverse relation to CV of median motor nerve (beta= 1.272, p<0.01), ulnar motor nerve (beta= 1.287, p<0.01), posterior tibial nerve (beta= 0.982, p<0.05), and deep peroneal nerve (beta= 1.449, p<0.05). CONCLUSION: This study indicates that HbA1c level was inversely related to motor nerve CV, and that sustained hyperglycemia may be involved in demyelination of motor nerves. Analysis of motor nerve CV related to HbA1c is expected to be useful in the follow-up or efficacy study of diabetes mellitus neuropathy as baseline data.