Perfil epidemiológico de pacientes atendidos en la consulta de pie diabético / Epidemiological profile of patients attended in the diabetic foot consultation

Introducción: El pie diabético tiene etiología multifactorial, con una prevalencia mundial de entre 1,3-4,8 por 100 mil habitantes. Objetivo: Identificar las principales características epidemiológicas de los pacientes con pie diabético. Métodos: Se realizó un estudio observacional descriptivo, de tipo serie de casos, en el Policlínico Docente "Área Este" de Camagüey, para analizar el quinquenio 2017-2021. Del universo de 301 pacientes fue seleccionada una muestra de 250. Se estudiaron las variables: grupo etario, sexo, años de evolución de la enfermedad, tipo de lesión desencadenante, factores de riesgo, tipo de úlceras y derivación a la atención secundaria. Para el procesamiento de los datos se empleó SPSS y los resultados se expresaron en valores absolutos y porcentajes. Resultados: Se obtuvo predominio del grupo etario 60 años y más (47,6 por ciento), y del sexo masculino (52,8 por ciento), con diabetes mellitus de evolución de 15 años y más (40,8 por ciento), heridas como lesión desencadenante (27,2 por ciento), hiperglucemia (70 por ciento), hipertensión arterial (81,2 por ciento), úlcera neuropática (48,0 por ciento), con necesidad de atención secundaria y necrectomía (48,4 por ciento). Conclusiones: En la serie estudiada se identificó un predominio del sexo masculino, la edad avanzada, y el antecedente de diabetes de larga evolución y de haber sufrido herida en el pie al momento de presentar hiperglucemia(AU)

Introduction: Diabetic foot has multifactorial etiology, with a worldwide prevalence of 1.3-4.8 per 100 000 inhabitants. Objective: To identify the main epidemiological characteristics of patients with diabetic foot. Methods: A descriptive observational study of case series type was carried out in the "East Area" Teaching Polyclinic of Camagüey, to analyze the five-year period 2017-2021. From the universe of 301 patients, a sample of 250 was selected. The following variables were studied: age group, sex, years of disease evolution, type of triggering lesion, risk factors, type of ulcers and referral to secondary care. SPSS was used for data processing and the results were expressed in absolute values and percentages. Results: There was a predominance of the age group 60 years and older (47.6 percent), and of the male sex (52.8 percent), diabetes mellitus with evolution of 15 years and more (40.8 percent), wounds as triggering lesion (27.2 percent), hyperglycemia (70 percent), hypertension (81.2 percent), neuropathic ulcer (48.0 percent), and with need for secondary care and necroctomy (48.4 percent). Conclusions: In the series studied, a predominance of male sex, advanced age, and a history of long-term diabetes and having suffered a foot injury at the time of hyperglycemia were identified(AU)

Efecto de la inmunidad celular en el tratamiento de las úlceras del pie diabético con Heberprot-P® / Effect of cellular immunity in the treatment of diabetic foot ulcers with Heberprot-P®

Introducción: Los diabéticos muestran una disminuida función del sistema inmune. Su complicación más temida es la aparición de las úlceras del pie. El Heberprot-P® tiene efectos beneficiosos en la curación de estas úlceras. Objetivo: Evaluar el efecto de la inmunidad celular en el tratamiento de las úlceras del pie diabético con Heberprot-P®. Métodos: Se realizó un estudio observacional, prospectivo, de serie de casos, en 30 pacientes con úlcera de pie diabético, ingresados en el Instituto Nacional de Angiología y Cirugía Vascular. Se administraron 75 µg de Heberprot-P®, tres veces por semana, a través de vías peri- e intralesional, durante ocho semanas. Se evaluaron las variables edad, sexo, glucemia en ayunas, creatinina, urea, ácido úrico, prueba de hipersensibilidad retardada, porcentaje de granulación, tiempo de cierre de la lesión y localización de la úlcera, antes de comenzar el tratamiento, a las 4 y 8 semanas. Resultados: Se precisó un predominio del 60 por ciento en el sexo femenino y del color de piel blanca. Los niveles de glucemia y creatinina se comportaron más elevados en los anérgicos; la urea fue similar tanto en anérgicos como en reactivos; y el ácido úrico resultó mayor en hombres reactivos y en mujeres anérgicas. Hubo mayor proporción de reactivos (63,6 por ciento), que en la cuarta semana presentaron un tejido de granulación igual o mayor al 50 por ciento; y a la octava, igual o mayor al 70 por ciento. Conclusiones: La condición en los pacientes diabéticos de ser reactivo a las pruebas de hipersensibilidad retardada con úlcera de pie diabético de tipo neuropática, tratados con Heberprot-P®, está asociada directamente con una mejor respuesta en la cicatrización de sus lesiones, mediante la formación del tejido de granulación, que favorece el cierre total o parcial de la lesión. Esto no ocurrió con los pacientes anérgicos a dicha prueba(AU)

Introduction: Diabetics show decreased immune system function. Its most feared complication is the appearance of foot ulcers. Heberprot-P® has beneficial effects in healing these ulcers. Objective: To assess the effect of cellular immunity in the treatment of diabetic foot ulcers with Heberprot-P®. Methods: An observational, prospective, case series study was conducted in 30 patients with diabetic foot ulcer admitted to the National Institute of Angiology and Vascular Surgery. 75 µg of Heberprot-P®, three times a week, were administered through peri- and intralesional routes, during eight weeks. The variables age, sex, fasting blood glucose, creatinine, urea, uric acid, delayed hypersensitivity test, percentage of granulation, time of closure of the lesion and location of the ulcer, before starting treatment, at 4 and 8 weeks were evaluated. Results: A predominance of 60 % in females and white skin color were specified. Blood glucose and creatinine levels behaved higher in the anergics; urea was similar in both anergics and reagents; and uric acid was higher in reactive men and anergic women. There was a higher proportion of reagents (63.6 por ciento), which in the fourth week presented a granulation tissue equal to or greater than 50 por ciento; and at the eighth week, it was equal to or greater than 70 por ciento. Conclusions: The condition of being reactive to delayed hypersensitivity tests in diabetic patients with diabetic foot ulcer of neuropathic type, treated with Heberprot-P® is directly associated with a better response in the healing of their lesions, through the formation of granulation tissue, which favors the total or partial closure of the lesion. This did not occur with patients who were anergic to this test(AU)

Asociación entre el índice de amputación por pie diabético y los indicadores de atención y manejo de diabetes mellitus tipo 2 en los Centros de Salud del Servicio Metropolitano Oriente, entre 2014 y 2018 / Association between the diabetic foot amputation index and metabolic compensation in diabetes mellitus

BACKGROUND: Diabetic foot amputation is a public health challenge due to the increasing prevalence of type 2 diabetes mellitus (T2D). Although there are many health indicators aimed at the management and control of T2D and its complications, amputations persist. Aim: To evaluate the association between diabetic foot amputation index and indicators of care and management of T2D in primary care centers of the eastern section of Santiago, Chile. MATERIAL AND MATHODS: We conducted a mixed ecological study and included information from the Monthly Statistical report of different public health centers from 2014 to 2018. We also analyzed the hospital discharge records from an individual tertiary public health center. The annual index for diabetic foot amputation per 100,000 diabetic patients was used as a response variable. The diabetic compensation percentage was calculated as the proportion of adults with a glycosylated hemoglobin below 7% or the proportion of older people with a value below 8%. The diabetic decompensation percentage was calculated as the proportion of people with a glycosylated hemoglobin over 9%. RESULTS: A high variability in demographic and management indicators was observed between communes and centers in the study period. Bivariate analysis showed a significant correlation between the amputation index, decompensation, and insulin use. In a regression analysis, the amputation index was significantly associated with the diabetic compensation percentage (β = -3.5; p < 0.05) and a high decompensation percentage (β = 12.3; p < 0.005). Conclusions: The diabetic foot amputation index was associated with diabetic compensation and decompensation indicators.

Resultados del tratamiento con Heberprot-P® en pacientes con diagnóstico de pie diabético / Outcomes of Treatment with Heberprot-P® in Patients Diagnosed with Diabetic Foot

Introducción: El pie diabético es una alteración clínica de base etiopatogénica neuropática e inducida por la hiperglucemia mantenida, en la que con o sin coexistencia de isquemia, y previo desencadenante traumático, produce lesión y/o ulceración del pie. Objetivo: Describir los resultados del tratamiento con Heberprot-P® en pacientes con pie diabético. Métodos: Estudio de corte transversal descriptivo y prospectivo en pacientes con pie diabético pertenecientes al policlínico Joaquín de Agüero y Agüero del municipio Camagüey, durante el período de julio del 2019 a julio del 2020. El universo de estudio estuvo integrado por un total de 60 pacientes con diagnóstico de pie diabético a quienes se les aplicó factor de crecimiento epidérmico. La información se procesó a través del paquete estadístico SPSS versión 21. Resultados: Predominaron los pacientes del grupo de edad de 65 a 74 años (35 por ciento), el sexo femenino (58,8 por ciento), con hipertensión arterial asociada (81,8 por ciento). El 38,4 por ciento de los diabéticos se presentaron con lesiones en los dedos, grado II (63,3 por ciento) según la escala de Wagner. Conclusiones: Con la aplicación del Heberprot-P® presentaron dolor (78,3 por ciento) como efecto adverso y una cicatrización total a la respuesta del tratamiento (96,6 por ciento), lográndose mantener la integridad del miembro(AU)

Introduction: Diabetic foot is a clinical alteration of neuropathic etiopathogenic basis, induced by maintained hyperglycemia, in which, with or without coexistence of ischemia, as well as previous traumatic trigger, foot injury or ulceration is produced. Objective: To describe the outcomes of treatment with Heberprot-P® in patients with diabetic foot. Methods: Descriptive and prospective cross-sectional study carried out in patients with diabetic foot belonging to the Joaquín de Agüero y Agüero Polyclinic of Camagüey Municipality, during the period from July 2019 to July 2020. The study universe was made up of a total of sixty patients diagnosed with diabetic foot who were applied epidermal growth factor. The information was processed through the statistical package SPSS version 21. Results: Patients in the 65-74 years age group predominated (35 percent), together with the female sex (58.8 percent), as well as associated arterial hypertension (81.8 percent). 38.4 percent of diabetic patients presented with finger lesions of grade II (63.3 percent) according to the Wagner's classification. Conclusions: With the application of Heberprot-P®, pain (78.3 percent) appeared as an adverse effect. There was also total healing as a response to treatment (96.6 percent), which permitted to maintain limb integrity(AU)

Enfermedad de Charcot de pie y tobillo en pacientes con diabetes mellitus: análisis de las causas de re consultas en una unidad de pie diabético hospitalaria / Charcot´s disease of the foot and ankle in diabetic patients: analysis of the reasons for re admission at the hospital diabetic unity / Neuroartropatía de Charcot do pé e tornozelo em pacientes com diabetes mellitus: análise das causas das novas consultas em uma unidade de pés diabéticos do hospital

La neuroartropatia de Charcot es una complicación devastadora para los pacientes diabéticos, generando deformidades osteoarticulares con riesgo de ulceración, infección y amputación de miembros inferiores. El objetivo fue analizar en una población de pacientes diabéticos con secuela de neuroartropatía de Charcot, el motivo de re consulta y los tratamientos a los que fueron sometidos. El mismo se realizó en forma retrospectiva mediante observación de historias clínicas y estudios radiológicos de 22 pacientes tratados entre 2014 y 2018 en el Hospital Policial de Montevideo - Uruguay, con un tiempo de evolución mínimo de un año al momento de la revisión. Se contó con la aprobación del Comité de Ética de dicho hospital habiéndose completado un formulario con datos demográficos, tratamiento inicial, causas de las re consultas y tratamientos secundarios. Si bien al inicio de la enfermedad se siguieron los protocolos de tratamiento con alto nivel de recomendación, se observaron en las re consultas elevados porcentajes de re ulceración y necesidad de cirugías complementarias (59%). Se vinculan los resultados a la falta de categorización de paciente de riesgo para lograr seguimiento y captación precoz. El categorizar al paciente de riesgo permite establecer estrategias de educación y de tratamientos tendientes a disminuir porcentajes de nuevas lesiones que lleven a la necesidad de tratamientos secundarios o amputaciones.

One of the most devastating complications within diabetic patients is Diabetic Charcot neuroarthropathy. It can lead to osteoarticular deformities, with risk of ulceration, infection or even lower limb amputation. In this paper, a population of diabetic patients with Charcot neuroarthropathy sequelae was studied. Data was analyzed on the reasons for the patients re consultation, the treatments they were subjected to and the obtained results. The study was conducted retrospectively by the examination of medical records from 22 patients that were treated between 2014 and 2018, with a follow-up of at least a year, at the Hospital Policial in Montevideo, Uruguay. Furthermore, it had the hospital's Ethics Committee approval. The data analysis was conducted by the completion of a form including demographic data, initial treatment, reasons for re consultation and secondary treatments. According to the findings, even though highly recommended protocols were followed at the onset of the disease, high percentage of ulceration and complementary surgeries were observed (59%) within the patient's data. The results are linked to the lack of risk patient´s categorization in order to achieve early uptake. Categorizing the patient at risk makes it possible to establish health education and treatment strategies aimed at reducing percentages of new injuries that lead to the need for secondary treatments or amputations.

A neuroartropatia de Charcot é uma complicação devastadora para os pacientes com diabetes, gerando deformidades osteoarticulares residuais com risco de úlceras, infecção e amputação maior dos membros inferiores. O objetivo foi analisar em uma população de pacientes diabéticos com sequelas da neuroartropatia de Charcot, o motivo da nova consulta e os tratamentos a que foram submetidos, bem como os resultados obtidos. Foi realizado retrospectivamente por meio de observação de histórias clinicas e estudos radiológicos de 22 pacientes atendidos no periodo de 2014 a 2018 no Hospital da Polícia de Montevidéu - Uruguai, com tempo de evolução mínimo de um ano na época da revisão. Foi aprovado pelo Comité de Ética do referido hospital, tendo sido preenchido um formulário com dados demográficos, tratamento inicial, causas das novas consultas e tratamentos secundários. Embora protocolos de tratamento com alto nível de recomendação tenham sido seguidos no início da doença, elevados percentuais de re ulcerações e cirurgias complementares (59%) foram observados nas novas consultas. Os resultados estão ligados à falta de categorização dos pacientes de risco para obter captação precoces A categorização do paciente de risco permite estabelecer estratégias de educação e tratamento com o objetivo de reduzir os percentuais de novas lesões que levam à necessidade de tratamentos secundários ou amputações.

Costos y resultados del tratamiento con Heberprot-P® en pacientes con pie diabético del Policlínico Ramón López Peña / Costs and Outcomes of Heberprot-P® Treatment in Patients with Diabetic Foot Ulcer from Ramón López Peña Polyclinic

Introducción: Las úlceras del pie diabético constituyen una de las principales causas de morbilidad y discapacidad, con una importante repercusión por la carga económica de la enfermedad y desde el punto de vista social, por la disminución de la calidad de vida de los pacientes. Objetivo: Evaluar costos y resultado del tratamiento ambulatorio con el Heberprot P® para la atención al paciente con úlcera del pie diabético. Métodos: Se realizó un estudio descriptivo, longitudinal y retrospectivo de 22 pacientes con pie diabético tratados con Heberprot-P®, en la consulta para tales fines del Policlínico Ramón López Peña en el año 2019. Resultados: El 63,6 por ciento de los pacientes que acudieron a consulta presentaron Pie de Riesgo grado cero; la úlcera neuroinfecciosa fue la de mayor incidencia de presentación (94,5 por ciento). Se obtuvo una efectividad del 95,4 por ciento del total de los casos tratados. La mayoría de los tratados necesitaron entre 3-8 bulbos del medicamento, con un promedio de 5 sesiones de tratamiento por paciente, a un costo promedio de $ 3 549,8 /caso tratado. Conclusiones: El tratamiento con el Heberprot P® es altamente efectivo para la cicatrización de las UPD, evitando en gran medida las amputaciones de los miembros inferiores de los pacientes con diabetes mellitus, con una consiguiente disminución del costo económico que tienen estas intervenciones sanitarias para el país(AU)

Introduction: Diabetic foot ulcer is one of the main causes of morbidity and disability, with an important repercussion due to the economic burden of the disease and from the social point of view, due to the decrease in patients' quality of life. Objective: To assess costs and outcomes of outpatient treatment with Heberpro-P® for the care of patients with diabetic foot ulcers. Methods: A descriptive, longitudinal and retrospective study was carried out of 22 patients with diabetic foot treated with Heberprot-P®, in the consultation for such purposes of Ramón López Peña Polyclinic in 2019. Results: 63.6 percent of the patients who came for consultation presented zero risk foot; neuroinfectious ulcer was the one with the highest incidence of presentation (94.5 percent). An effectiveness rate of 95.4 percent of the total of treated cases was obtained. Most of those treated needed three to eight bulbs of the medication, with an average of five treatment sessions per patient, at an average cost of 3549.8 Cuban pesos per treated case. Conclusions: Treatment with Heberprot-P® is highly effective for the healing of diabetic foot ulcers, largely avoiding amputations of lower limbs of patients with diabetes mellitus, with a consequent decrease in the economic cost of these health interventions for the country(AU)

Impacto da COVID-19 no perfil cirúrgico dos pacientes de cirurgia vascular em serviço de referência em Curitiba / Impact of COVID-19 on the surgical profile of vascular surgery patients at a tertiary hospital in Curitiba, Brazil

Resumo Contexto Na pandemia de covid-19, os serviços de saúde diminuíram os atendimentos e procedimentos eletivos. Pacientes de cirurgia vascular são grupo de risco para adquirir formas graves da infecção, ao mesmo tempo que são suscetíveis a apresentar complicações de suas doenças de base caso não tenham acompanhamento rotineiro. Dessa forma, faz-se necessário entender os impactos e as consequências diretas e indiretas da pandemia com relação aos pacientes vasculares. Objetivos Avaliar o impacto de 1 ano de pandemia em um serviço de Cirurgia Vascular, assim como a mudança do perfil de cirurgias no mesmo período. Métodos Foi feita a análise de prontuários de pacientes submetidos a cirurgias eletivas e de urgência entre 2019 e 2021. Em conjunto, foi realizada uma revisão de literatura com as palavras-chave "cirurgia vascular", "covid-19" e "amputações". Os dados foram analisados com o programa computacional Stata/SE v.14.1 (StataCorpLP, EUA). Resultados Foram identificadas 1.043 cirurgias no período de estudo, sendo 51,6% pré-pandemia e 48,4% durante a pandemia. Observou-se redução no número de cirurgias eletivas e aumento no número de amputações de membros inferiores e desbridamentos cirúrgicos. Foi possível observar também aumento de pacientes com doença arterial obstrutiva periférica com classificação de Rutherford avançada, assim como de casos de pé diabético. Conclusões A diminuição dos atendimentos eletivos e o receio dos pacientes em procurar os serviços de saúde durante o período da pandemia são os prováveis motivos que justificam o aumento da gravidade dos quadros dos pacientes, com maior necessidade de amputação de membros inferiores, desbridamento cirúrgico e mudanças no perfil de cirurgia do serviço.

Abstract Background During the COVID-19 pandemic, healthcare services reduced the number of elective procedures performed. Vascular surgery patients are a group at risk of contracting severe forms of the infection, but are also susceptible to complications of their underlying diseases if they do not receive routine care. It is therefore necessary to understand the direct and indirect impacts and consequences of the pandemic on vascular patients. Objectives To assess the impact of 1 year of the pandemic on a vascular surgery service and changes to the profile of surgeries during the same period. Methods An analysis was conducted of the medical records of patients who underwent elective and emergency surgery from 2019 to 2021. A review of the literature was also conducted, using the search terms "vascular surgery", "COVID-19", and "amputations". Data were analyzed with Stata/SE v.14.1 (StataCorpLP, United States). Results A total of 1,043 surgeries were identified during the study period, 51.6% conducted pre-pandemic and 48.4% performed during the pandemic. There was a reduction in the number of elective surgeries and an increase in the number of lower limb amputations and surgical debridements. Increases were also observed in the proportion of patients with peripheral arterial occlusive disease with advanced Rutherford classifications and in the number of cases of diabetic foot. Conclusions The reduction in elective care and patients' reluctance to seek health services during the pandemic are the probable causes of increased severity of patient status, with greater need for lower limb amputation and surgical debridement and changes to the profile of the surgery performed at the service.

Avaliação do autocuidado com os pés entre pacientes portadores de diabetes melito / Evaluation of self-care with feet among patients with diabetes mellitus

Resumo Contexto O pé diabético é uma complicação do diabetes melito (DM), sendo a maior causa de amputação dos membros inferiores. Objetivos Avaliar a prática de medidas de autocuidado com os pés, segundo sexo e escolaridade, em pacientes portadores de DM na região nordeste no estado da Bahia. Métodos Estudo quantitativo, observacional, analítico, transversal, realizado com 88 pacientes portadores de DM, em consulta de rotina, de fevereiro a março de 2020. A coleta de dados foi executada através da aplicação de questionários socioeconômico e do autocuidado com os pés (conhecimento sobre pé diabético, hábitos de cuidado/inspeção dos pés e procura pela Unidade de Saúde na presença de alterações com a saúde dos pés). Resultados Do total, 58% dos indivíduos desconhecia o termo "pé diabético", porém possuíam cuidados mínimos adequados com os pés, como inspecioná-los (60,2%), hidratá-los (65,9%), não andar descalço (81,8%) e cortar as unhas (92%), apesar de 90,9% não utilizar sapatos considerados adequados. Houve relação entre menor nível de escolaridade e pior desempenho nas questões referentes a andar descalço, hidratar os pés, cortar as unhas, usar calçados adequados e identificar micoses (p < 0,05), porém não houve associação da realização das medidas de autocuidado e sexo. Conclusão Os portadores de DM entrevistados não realizaram todas as medidas de autocuidado com os pés e desconheciam o termo "pé diabético". Houve associação entre menor escolaridade e menor capacidade de realização dessas medidas, o que sugere que o letramento em saúde seria importante para melhoria desse autocuidado, contribuindo para diminuição de complicações e amputações dos pés.

Abstract Background The diabetic foot is a complication of diabetes mellitus (DM) and is the most common cause of lower limb amputation. Objectives To assess foot self-care practices by sex and educational level in DM patients from the Northeast of Brazil, state of Bahia. Methods This was a quantitative, cross-sectional, observational, analytical study with 88 DM patients seen at routine consultations from February to March of 2020. Data were collected using questionnaires on socioeconomic data and self-care of feet (knowledge about the diabetic foot, habits related to care/inspection of feet, and visits to the Healthcare Center when changes to foot health are detected). Results 58% of the sample did not know the term "diabetic foot", but a majority did perform minimum adequate foot care practices, such as inspecting feet (60.2%), moisturizing feet (65.9%), avoiding walking barefoot (81.8%), and trimming toenails (92%), although 90.9% did not wear footwear considered appropriate. There was a relationship between lower educational level and worse performance in questions relating to walking barefoot, moisturizing feet, trimming toenails, wearing appropriate footwear, and identifying mycoses (p < 0.05), but there was no association between performing self-care activities and sex. Conclusions Interviewed patientswith DM did not perform all foot self-care activities and did not know what the term "diabetic foot" means. There was an association between lower educational level and reduced capacity to perform these activities, which suggests that health literacy is important to improve self-care of feet, contributing to reduce complications and foot amputations.

Clinical characteristics and risk factors of lower extremity arterial disease in patients with diabetic foot ulcer / 南方医科大学学报

OBJECTIVE@#To investigate the clinical characteristics of lower extremity arterial disease (LEAD) and its risk factors in patients with diabetic foot ulcer (DFU).@*METHODS@#We retrospectively collected the clinical and follow-up data of 650 patients with DFU treated in the Department of Endocrinology and Metabolism of Nanfang Hospital between January, 2017 and December, 2019. We compared the data between patients who had LEAD and those without LEAD and used a multivariate logistic regression model to analyze the risk factors of LEAD in DFU patients.@*RESULTS@#Among the 650 DFU patients, 470 (72.4%) had LEAD. The patients were followed up for a mean of 3.5 months, and the mean healing time of DFU was 2.55 months; healing of DFU occurred in 453 patients and 183 patients received amputation. The patients with LEAD and those without LEAD differed significantly in age, hospitalization costs, diastolic blood pressure (DBP), glycated hemoglobin, blood lipid levels, disease course, ankle brachial index, healing time, smoking history, clinical outcomes, Wagner grade and imaging results (P < 0.05). Multivariate logistic regression analysis identified age (OR=1.070, 95% CI: 1.049-1.091), smoking history (OR= 2.013, 95% CI: 1.268-3.195), and a decreased DBP (OR=0.980, 95% CI: 0.963-0.997) as independent risk factors for LEAD in DFU patients. A prolonged healing time was a prominent clinical feature of DFU complicated by LEAD.@*CONCLUSION@#DFU patients have a high incidence of LEAD, which leads to high rates of disability and mortality and is associated with an advanced age, high smoking rate and longer healing time. A decreased DBP is also a risk factor for LEAD in DFU patients.

Representações sociais sobre pé diabético: contribuições para atenção primária à saúde no nordeste brasileiro / Social representations on diabetic foot: contributions to PHC in the brazilian northeast

Resumo A investigação tem por objetivo identificar os elementos estruturantes que orientam a formação das representações sociais do pé diabético entre pessoas com diabetes mellitus. Estudo qualitativo, fundamentado na Teoria das Representações Sociais, seguindo a vertente estrutural complementar, realizado em uma capital do Nordeste brasileiro, de fevereiro a maio de 2019, com a participação de 100 pessoas com pé diabético. Para a coleta dos dados, utilizou-se o teste de associação livre de palavras e o roteiro para caracterização do perfil sociodemográfico e clínico. A análise foi realizada por meio do software openEVOC. Os elementos constituintes da representação social do pé diabético referem-se às evocações são "cura" e "muito ruim", e revelam que viver com pé diabético é desafiador, mas que há uma esperança de cura que se constitui em mola propulsora na busca cotidiana do cuidado. O elemento prevenção apareceu no campo representacional, o que denota uma visão mais crítica, podendo transformar os elementos nucleares identificados. Constata-se que a estrutura representacional encontra-se ancorada em conteúdos subjetivos, valorativos e atitudinais. Conclui-se que este conhecimento pode contribuir com o desenho de intervenções que auxiliem nas práticas de cuidados e rastreamento do pé diabético nos serviços ofertados na Atenção Primária à Saúde.

Abstract This study aimed to identify the structuring elements guiding the establishment of the social representations of diabetic foot among people with diabetes mellitus. This qualitative study is based on the Social Representations Theory and was conducted in a capital of the Brazilian Northeast. The free word association test and a roadmap were used to characterize the sociodemographic and clinical profile to collect data. The analysis was performed using openEVOC software. The constituent elements of the diabetic foot's social representation "cure" and "really bad", revealing that living with a diabetic foot is challenging, but there is hope for a cure, which is a driving force in the daily search for care. The "prevention" element emerged in the representational field, denoting a more critical view and a capacity to transform the identified core elements. We found that the representational structure is based on subjective, valuating, and attitudinal contents. This knowledge can contribute to the design of interventions in the provision of care and diabetic foot screening in PHC services.

Impacto da hipertensão arterial na prevalência do pé diabético no Brasil: uma análise de 10 anos / Impact of hypertension on the prevalence of diabetic foot in Brazil: a 10-year analysis

Introdução: O diabetes mellitus é uma doença de alta prevalência, tanto em países em desenvolvimento quanto nos países desenvolvidos tendo como um dos seus principais fatores risco a hipertensão arterial e como uma de suas complicações vasculares o desenvolvimento do pé diabético. Objetivo: Realizar uma comparação entre a prevalência do pé diabético entre indivíduos diabéticos normotensos e indivíduos diabéticos hipertensos para definir se a hipertensão atua como fator agravador dessa complicação. Método: Estudo epidemiológico, descritivo e retrospectivo, com dados retirados do departamento de informática do sistema único de saúde (DATASUS), através do TABNET pelo programa HIPERDIA, que acompanha indivíduos hipertensos e/ou diabéticos. O período analisado foi janeiro de 2002 até janeiro de 2012, totalizando 10 anos de análise. Os dados referentes às variáveis "diabetes tipo 01" e "diabetes tipo 02" foram somadas, formando o grupo de indivíduos diabéticos normotensos. E os dados referentes à variável "hipertensão com diabetes" formou o grupo de indivíduos diabéticos hipertensos. Desses grupos, foi selecionado os indivíduos com pé diabéticos e esses dados foram sumarizados, a partir de cálculos de proporção, agrupados no Excel® e foi aplicado o teste exato de Fisher. Resultados: A proporção do pé diabético em indivíduos diabéticos normotensos foi de 3,14%, já em indivíduos diabéticos hipertensos foi de 4,38%, sendo seus dados estatisticamente significante (OR: 1,43; IC 95%, 1,34-1,51; p <0,001). O perfil epidemiológico de diabéticos normotensos tem maior prevalência no sexo masculino, em 50-54 anos, 24,05% tabagistas e 30,41% com sobrepeso. Os diabéticos hipertensos apresentam maior prevalência no sexo feminino, em 60-64 anos, 30,48% tabagistas e 46,51% com sobrepeso. Conclusão: Conclui-se que a hipertensão arterial atua como um significante fator agravador para o desenvolvimento do pé diabético. Sendo assim, diante da escassez de estudos, o presente trabalho mostra-se relevante, servindo como base na compreensão dos aspectos epidemiológicos acerca da relação entre diabetes e hipertensão.

Introduction: Diabetes mellitus is a disease of high prevalence, both in developing and developed countries, having as one of its main risk factors hypertension and as one of its vascular complications the development of diabetic foot. Objective: To compare the prevalence of diabetic foot between normotensive diabetic and hypertensive diabetic individuals to define if hypertension acts as an aggravating factor of this complication. Method: Epidemiological, descriptive and retrospective study, with data taken from the informatics department of the single health system (DATASUS), through TABNET, where was accessed the HIPERDIA program, which follows hypertensive and / or diabetic individuals. The period analyzed was from January 2002 to January 2012, totaling 10 years of analysis. Data referring to the variables "type 01 diabetes" and "type 02 diabetes" were summed, forming the group of normotensive diabetic individuals. And data regarding the variable "hypertension with diabetes" formed the group of hypertensive diabetic individuals. From these groups, we selected individuals with diabetic foot and these data were summarized from proportion calculations, grouped in Excel® and Fisher's exact test was applied. Results: The proportion of diabetic foot in normotensive diabetic individuals was 3.14%, while in hypertensive diabetic individuals it was 4.38%, with statistically significant data (OR: 1.43; 95% CI 1.34- 1.51; p <0.001). The epidemiological profile of normotensive diabetics is more prevalent among males, aged 50-54 years, 24.05% smokers and 30.41% overweight. Hypertensive diabetics are more prevalent in females, aged 60-64 years, 30.48% smokers and 46.51% overweight. Conclusion: It is concluded that hypertension acts as a significant aggravating factor for the development of diabetic foot. Thus, given the scarcity of studies, the present study is relevant, serving as a basis for understanding the epidemiological aspects of the relationship between diabetes and hypertension.

Tratamiento quirúrgico de pie diabético basado en clasificación Wagner / Surgical treatment of diabetic foot based on Wagner classification

Se realizó un estudio que caracterizó a los pacientes que reciben tratamiento quirúrgico en el Hospital Roosevelt por pie diabético según la Clasificación Wagner. El objetivo era determinar el tratamiento quirúrgico brindado al paciente con pie diabético, basado en la clasificación Wagner, en el Departamento de Cirugía del Hospital Roosevelt durante el período de enero a octubre 2015. Se realizó un estudio descriptivo estudiando a los pacientes con diagnóstico de pie diabético, con una muestra de 81 pacientes. Se encontró que 56% presentaron grado IV, edad de 56-65 años en 38%, de sexo masculino 65%. 134 procedimientos quirúrgicos realizados, más común lavado y desbridamiento en 38%. Principalmente diagnóstico de Diabetes mellitus tipo II, con tiempo diagnóstico mayor a 10 años en 51%. Uso de hipoglucemiantes orales 49%. De los estudiados, 41% no presentaba ninguna comorbilidad. Se concluyó que el tratamiento quirúrgico más frecuente para Pie diabético Wagner II y III fue el lavado y desbridamiento, grado IV amputación de dedos y grado V las amputaciones femorales supracondíleas. Caracterizados como pacientes en rango de edad entre los 56-65 años, de sexo masculino, que padece Diabetes mellitus tipo II, clasificado como pie diabético Wagner IV, ameritando tratamiento quirúrgico como amputación de dedos seguido de amputaciones radicales descritas como amputación supracondílea, con tiempo de diagnóstico mayor a 10 años, con tratamiento de hipoglucemiantes orales, y sin ninguna comorbilidad médica asociada. (AU)

A study was conducted that characterized patients receiving surgical treatment at Roosevelt Hospital for diabetic foot according to the Wagner Classification. The objective was to determine the surgical treatment provided to the patient with diabetic foot, based on the Wagner classification, in the Department of Surgery at Roosevelt Hospital during the period from January to October 2015. A descriptive study was carried out studying patients with a diagnosis of diabetic foot, with a sample of 81 patients. It was found that 56% had grade IV, age 56-65 years in 38%, male 65%. 134 surgical procedures performed, the most common was lavage and debridement in 38%. Mainly diagnosis of type II diabetes mellitus, with a diagnosis time greater than 10 years in 51%. Use of oral hypoglycemic agents 49%. Of those studied, 41% did not present any comorbidity. The conclusion was that the most frequent surgical treatment for Wagner II and III was lavage and debridement, grade IV finger amputation and grade V supracondylar femoral amputations. Characterized as patients in the age range between 56-65 years, male, suffering from type II diabetes mellitus, classified as Wagner IV diabetic foot, meriting surgical treatment such as amputation of fingers followed by radical amputations described as supracondylar amputation, with time of diagnosis greater than 10 years, with treatment of oral ypoglycemic agents, and without any associated medical comorbidity. (AU)

Diabetic foot and COVID-19. Medical consultation and severity of lesions compared to 2019 / Pie diabético y COVID-19. Número de consultas y gravedad de las lesiones comparadas con 2019

Abstract At the end of 2019 a novel coronavirus was identified as a cause of pneumonia in Wuhan, China. This emerging disease has caused an unexpected turn in the economy and in society, which has led to the necessity of social isolation and confinement. Diabetic foot consultation was affected by the ongoing situation. The aim of this study was to compare the number of medical visits and the severity of new lesions at presentation at the Diabetic Foot Unit during June 2020 compared to June 2019. Three hundred and fifty six medical visits were analyzed, resulting in a 29% reduction in the number of visits during 2020. The number of patients presenting with new lesions increased from 6.4% to 10.3% (p = ns) during pandemic. The number of visits from the patients´ relatives was higher during June 2020 (16.3% vs. 1.4%) (p < 0.05). Controls of feet without active lesions (i.e.: closed wound or periodic control) decreased from 16.8% to 4.5% (p < 0.05). Consultation for medical prescription only was higher in 2020 (22.4%) than in 2019 (7.3%) (p < 0.05). In our sample, there were no significant differences in the severity of new lesions at presentation or on the days of evolution of new ones in comparison with the previous year. During 2020, telehealth consults represented a 7% of all medical visits. There were no major amputations during 2019 and 4 during 2020. Given the dynamics of confinement, further studies about this topic are required to make sound and accurate decisions.

Resumen A fines de 2019 se identificó un nuevo coronavirus como causa de neumonía, en Wuhan, China. Esta nueva enfermedad (COVID-19) causó un inesperado vuelco en la economía y en la sociedad. El aislamiento social y el confinamiento provocaron cambios en la dinámica de las consultas médicas. En este estudio se compararon la cantidad de consultas y la gravedad de las lesiones nuevas en la Unidad de Pie Diabético entre junio de 2020 y junio de 2019. Se analizaron en total 356 visitas médicas, hallando un 29% de reducción en el número de visitas en 2020. El número de consultas por lesión nueva aumentó del 6.4% a 10.3% (p = ns) durante la pandemia. Las visitas de familiares por diversos motivos en lugar del paciente aumentaron durante 2020 de 1.4% a 16.3% (p < 0.05). Los controles de pacientes sin lesión (pie de alto riesgo, control post alta), disminuyeron de 16.8% a 4.5% (p < 0.05) y también aumentaron las visitas únicamente para prescripciones médicas (7.3% a 22.4%, p < 0.05). En nuestra muestra, no hubo diferencias significativas en la gravedad de la presentación ni en los días de evolución de las lesiones nuevas en relación al año anterior. Durante 2020 las teleconsultas representaron el 7% del total. En junio de 2019 no se registraron amputaciones mayores y en 2020 se registraron 4. Dada la dinámica del confinamiento, se requiere un continuo seguimiento y nuevos estudios para evaluar las consecuencias que se producirán en los pacientes con esta enfermedad con el fin de tomar decisiones acertadas.

Lesiones complejas en pie diabético neuroinfeccioso y su tratamiento con Heberprot-P® / Complex lesions in neuroinfectious diabetic foot and its treatment with Heberprot-P®

La prevalencia mundial del pie diabético oscila en un 6,4 por ciento. La amputación en personas con diabetes es de 10 a 20 veces más frecuente que en los no diabéticos y, cada 30 segundos, en algún lugar del mundo alguien sufre la amputación de una extremidad inferior como consecuencia de esta. El Heberprot-P® constituye un producto indicado y registrado por Cuba para el tratamiento de pacientes con úlceras neuropáticas y neuroisquémicas del pie diabético, que en este caso resulta una lesión compleja, en estado avanzado y con alto riesgo de amputación (Wagner 4). Este estudio tuvo como objetivo presentar un caso que demuestra la eficacia de la cicatrización de una lesión compleja del pie diabético mediante el tratamiento con Heberprot-P®. Se trata de un paciente de 47 años, diabético de tipo 1, que ingresó en el Hospital "Dr. Mario Muñoz Monroy" de la provincia de Matanzas, en 2017, con el diagnóstico de pie diabético neuroinfeccioso, y lesiones en primer dedo y base plantar de todos los dedos (grado 4, según clasificación de Wagner). Se le realizó desarticulación del primer dedo y necrectomía plantar. Posteriormente, previo control metabólico y de la sepsis, se le hicieron 21 infiltraciones de Heberprot-P® (75 µg) en un período de 45 días. Finalmente, se logró una epitelización de aproximadamente un 95 por ciento de la lesión. De este modo, quedó mostrada la eficacia en la cicatrización de lesiones complejas del pie diabético mediante el uso del Heberprot-P®(AU)

The global prevalence of diabetic foot ranges from 6.4 percent. Amputation in people with diabetes is 10 to 20 times more common than in non-diabetics and every 30 seconds somewhere in the world someone suffers the amputation of a lower limb as a result of diabetes. Heberprot-P® constitutes a product indicated and registered by Cuba for the treatment of patients with neuropathic and neuroischemic ulcers of the diabetic foot, which in this case results in a complex injury, in advanced state and with high risk of amputation (Wagner 4). This study aimed to present a case that demonstrates the effectiveness of healing from a complex diabetic foot wound treated with Heberprot-P®. It was the case of a 47-year-old male diabetic type 1 patient who was admitted at "Dr. Mario Muñoz Monroy" Hospital in Matanzas province, in 2017, with the diagnosis of neuroinfectious diabetic foot, and lesions in the first finger and plantar base of all fingers (grade 4, according to Wagner's classification). It was conducted a disarticulation of the first toe and a plantar necrectomy. Subsequently, after metabolic control and sepsis, 21 infiltrations of Heberprot-P® (75 g) were made over a period of 45 days. Finally, an epithelialization of approximately 95 percent of the wound was achieved. In this way, the effectiveness in healing complex lesions of the diabetic foot was shown through the use of Heberprot-P®(AU)

Demographic and socioeconomic profiles of patients admitted with diabetic foot complications in a tertiary hospital in Belem - Para / Perfil socioeconômico e demográfico de pacientes internados por complicações nos pés diabéticos em um hospital terciário em Belém - Pará

ABSTRACT Objective: to assess the socioeconomic and demographic profiles of patients hospitalized with a diagnosis of diabetic foot in a tertiary hospital in Belem-PA, Brazil, as well as to evaluate risk factors for lower limb amputations in such patients, classifying them according to the Wagner and PEDIS classifications. Methods: we conducted a descriptive, cross-sectional, unicentric, and analytical study carried out through a structured questionnaire. Results: the study consisted of 57 patients, aged between 48 and 84 years old, 66.7% being male. The average income ranged between one and three (61.4%) minimum wages and below one minimum wage (31.6%). Type II Diabetes Mellitus was predominant (86.0%). Concerning comorbidities, arterial hypertension displayed the highest proportion (62.3%), followed by dyslipidemia (52.8%). Smokers comprised 35.1% of the sample. Infectious diabetic foot (50.9%) and mixed diabetic foot (49.1%) were the most common. Of the 20 patients with previous amputation, 90% had undergone minor amputation, and 10%, major ones. Callosity (92.6%) was the most prevalent deformity. Fifty-four (94.7%) patients underwent surgery, those being debridement (24.1%), minor amputation (37.0%) and major amputation (38.9%). During hospitalization, 78.9% of individuals did not require ICU stay. Hospitalization time varied between three and 59 days, and 78.9% of hospitalized patients did not progress to death, but 43.1% of patients submitted to major amputations died. Conclusion: patients with diabetic foot followed-up have a low socioeconomic profile; most of them underwent surgical procedures, whether major or minor, due to the higher prevalence of infectious diabetic foot and/or non-adherence to non-operative treatment.

RESUMO Objetivo: traçar o perfil socioeconômico demográfico de pacientes internados com diagnóstico de pé diabético em um hospital terciário de Belém-PA, bem como avaliar os fatores de riscos para amputações de membros inferiores classificando-os de acordo com os critérios de Wagner e PEDIS. Métodos: estudo descritivo, transversal, unicêntrico e analítico realizado mediante questionário estruturado com perguntas objetivas e com posterior análise estatística descritiva de pacientes diagnosticados com pé diabético em um hospital terciário de Belém-PA. Resultados: estudo foi composto por 57 pacientes, com idade variando entre 48 e 84 anos, sendo 66,7% masculino. A renda medida oscilou entre 01 a 03 salários. O Diabetes Mellitus do tipo II foi predominante (86,0%). HAS foi a doença associada mais prevalente (62,3%), seguida da Dislipidemia (52,8%). Havia 35,1% fumantes. O tipo mais comum de pé diabético foi o neuropático (59,6%), seguido pelo infeccioso (50,9%) e o misto (49,1%). O tempo de hospitalização variou entre 03 e 59 dias. 43,1% dos pacientes que foram submetidos a amputações maiores faleceram. Conclusão: a ocorrência de pé diabético foi maior nos pacientes do sexo masculino com mais de 50 anos de idade. Predominaram pacientes de baixa renda e com pouca escolaridade. A maioria dos pacientes foram acometidos por pé diabético do tipo II e padrão infeccioso e, que necessitaram de intervenção. A maioria dos pacientes foi admitido com classificações mais avançadas de Wagner e PEDIS, o que estava associado à altas taxas de amputações, impactando nos desfechos de mortalidade.

Prevalência de lesões em órgãos-alvo em diabéticos tipo 2 / Prevalence of lesions in target organs in type 2 diabetes patients

Objetivo: Analisar a prevalência de lesões em órgãos-alvo. Métodos: Foi realizado estudo transversal e retrospectivo utilizando dados do Sistema de Cadastramento e Acompanhamento de Hipertensos e Diabéticos considerando diabéticos tipo 2 do Estado de Minas Gerais, entre os anos de 2003 e 2012. Foram analisadas quatro lesões características da má evolução do diabetes mellitus tipo 2: infarto agudo do miocárdio, acidente vascular cerebral, pé diabético e doença renal crônica. Resultados: Foram encontrados 36.270 diabéticos tipo 2. O infarto agudo do miocárdio acometeu 2,9% dos pacientes, gerando 1.087 casos. A idade mais atingida foi acima de 40 anos. O acidente vascular cerebral acometeu 2,4% dos diabéticos, provocando 892 ocorrências. A idade de maior prevalência se situou entre 50 e 64 anos, sendo responsável por 41,4% dos casos. O sexo feminino apresentou superioridade, sendo responsável por 56% dos casos. O pé diabético foi registrado em 1.160 pacientes, somando 3,1% do total de diabéticos. A doença renal crônica foi a lesão secundária ao diabetes mellitus tipo 2 mais prevalente no estado, gerando 2.094 registros, o que representa 5,7% do total de diabéticos. O sexo feminino foi consideravelmente mais acometido (65,1% dos casos), sendo a faixa etária entre 45 e 64 anos a mais prevalente. Conclusão: Este estudo sobre a prevalência e os fatores de risco para o desenvolvimento de lesões secundárias em diabéticos tipo 2 de Minas Gerais permitiu identificar que se trata de complicações muito prevalentes no Estado, e que os aspectos clínicos analisados constituem importantes fatores de risco para a má evolução da doença. (AU)

Objective: To analyze the prevalence of target organ damage. Methods: A cross-sectional and retrospective study was performed using data from the Hypertensive and Diabetic Patients Registry and Monitoring System considering type 2 diabetes patients from the state of Minas Gerais, from 2003 to 2012. Four characteristic lesions due to poor evolution of type 2 diabetes mellitus were analyzed: acute myocardial infarction; Stroke; Diabetic foot; Chronic kidney disease. Results: A total of 36,270 type 2 diabetic patients was found. Acute myocardial infarction affected 2.9% of the patients, generating 1,087 cases. The most affected age was over 40 years. Stroke affected 2.4% of diabetics, causing 892 occurrences. The highest prevalence age was between 50 and 64 years, accounting for 41.4% of the cases. The female gender was prevalent, being responsible for 56% of the cases. The diabetic foot was recorded in 1,160 patients, accounting for 3.1% of the total number of diabetics. Chronic kidney disease was the most prevalent lesion secondary to diabetes mellitus in the state, generating 2,094 records, representing 5.7% of the total number of diabetics. The female gender was considerably more affected (65.1% of the cases), with the age group between 45 and 64 years being more prevalent. Conclusion: This study of the prevalence and risk factors for the development of secondary lesions in type 2 diabetics from Minas Gerais allowed us to identify that these are very prevalent complications in the state, and that the clinical aspects analyzed are important risk factors for poor outcome of the disease. (AU)

Fatores associados ao controle glicêmico de pessoas com diabetes mellitus / Factors associated with glycemic control in people with diabetes mellitus

Resumo Investigar os fatores associados ao controle glicêmico de pessoas com diabetes mellitus (DM). Estudo transversal realizado com 746 pessoas com DM tipo 2 e 40 anos ou mais de idade. Elegeu-se as seguintes variáveis: socioeconômicas, dados clínicos, estilo de vida e o risco para o desenvolvimento de úlceras nos pés. A coleta dos dados ocorreu por meio de entrevista, análise do prontuário e exame clínico dos membros inferiores. Utilizou-se o modelo de regressão múltipla de Poisson para determinação das razões de prevalência (RP) brutas e ajustadas da alteração do exame de hemoglobina glicada (HbA1c), considerada como variável dependente desta pesquisa, sendo esta classificada como elevada quando o valor apresentava resultado superior a 7%. Identificou-se a elevação da HbA1c em 68,9% dos participantes e foi mais prevalente em indivíduos com idade entre 50 e 69 anos (RP = 1,38/IC95% = 1,09-1,75), os que faziam uso de insulina (RP = 1,35/IC95% = 1,24-1,47), obesos (RP = 1,14/IC95% = 1,03-1,25) e naqueles que possuíam risco de ulceração nos pés (RP = 1,14/IC95% = 1,09-1,28). Os indivíduos na faixa etária entre 50 e 69 anos, os que faziam uso de insulina, os obesos e os que possuíam risco de ulceração nos pés apresentaram maiores taxas de prevalência de alteração na hemoglobina glicada.

Abstract Investigate the factors associated with the glycemic control in people with diabetes mellitus (DM). Cross-sectional study with 746 people with type-2 DM of age 40 or older. The following variables were selected: socioeconomic, clinical data, lifestyle and the risk of developing foot ulcers. Data collection occurred through interviews, medical record analysis and clinical examination of the lower limbs. We used the Poisson multiple regression model to determine the crude and adjusted prevalence ratios (PR) of the glycemic alteration. The alteration in the glycated hemoglobin (HbA1c) test was considered as a dependent variable in this study, which has been classified as high when the result was higher than 7%. The alteration in HbA1c was present in 68.9% of the participants and was more prevalent in individuals aged between 50 and 69 (PR = 1.38/IC95% = 1.09-1.75), who were taking insulin (PR = 1.35/IC95% = 1.24-1.47), obese (PR = 1.14/IC95% = 1.03-1.25) and who had foot ulceration risk (PR = 1.14/IC95% = 1.09-1.28). Individuals aged between 50 and 69; the ones who used insulin; the obese ones; and those who had a risk of foot ulceration, presented higher prevalence rates of alteration in the glycated hemoglobin.

Pie diabético en pacientes internados en hospitales de Latinoamérica / Diabetic foot among hospitalized patients in Latin America

El pie diabético es una afección compleja. En su evolución puede demandar atención de primer nivel al inicio, atención de tercer nivel cuando aparecen complicaciones más graves, y con frecuencia internación para procedimientos complejos de diagnóstico y tratamiento. El conocimiento de la frecuencia de este cuadro entre los pacientes internados en hospitales de Latinoamérica permite hacer un diagnóstico de situación, la toma de decisiones y la programación de políticas de salud sobre la base de información concreta. Presentamos un estudio descriptivo, transversal, que consistió en analizar información colectada de 11 357 pacientes internados en 135 centros de diferente nivel de complejidad localizados en 9 países de Latinoamérica con el objetivo de determinar la prevalencia de diabetes mellitus, la tasa de pie diabético y parámetros relacionados. La prevalencia de diabetes mellitus en la internación fue 18.6% (IC 95%; 14.1-15.4), la tasa de pie diabético fue 14.8% (IC 95%; 14.1-15.4) y la de pie diabético con lesiones clasificadas como Wagner ≥ 1 fue 5.2% (IC 95%; 4.8-5.6). El pie diabético fue el motivo de internación en el 3.7% del total de internados y en el 20% de aquellos con diabetes mellitus. En nuestro conocimiento, nuestro estudio es el primero de esta envergadura en Latinoamérica, y sienta las bases para nuevos trabajos de investigación que permitirán un diagnóstico acabado de diferentes aspectos relacionados al pie diabético en la Región.

The diabetic foot is a complex condition. Along its course, it may require primary health care at the beginning, tertiary health care when more severe complications arise, and hospitalization when specialized management involving complex diagnostic and therapeutic procedures becomes peremptory. Determining frequencies of diabetic foot in hospitalized patients provides baseline data on the status of this condition aiming to an effective decision making process at the public health level. This transversal study consisted in analyzing data of 11 357 inpatients from 135 health centers in 9 Latin American countries in order to assess the prevalence of diabetes mellitus, the frequency of diabetic foot and related parameters in hospitalized patients in the region. The prevalence of diabetes mellitus was 18.6% (IC 95%; 14.1-15.4). The rate of diabetic foot was 14.8% (IC 95%; 14.1-15.4) and that of diabetic foot classified as Wagner ≥ 1 was 5.8% (IC 95%; 4.8-5.6). Diabetic foot was the reason for admission for 3.7% of all inpatients and for 20% of those who were diabetic. In our knowledge, this study is the largest in Latin America, and lays the foundation for further advances in the knowledge of the burden of diabetic foot.

Pie de riesgo en personas con diabetes mellitus de tipo 2 en la Atención Primaria de Salud durante 2016 / Risky feet in patients with diabetes mellitus type 2 in the Primary Health Care during 2016

Se realizó un estudio observacional, descriptivo y transversal para determinar la estratificación del pie de riesgo y los factores concurrentes en 534 pacientes con diabetes mellitus de tipo 2, pertenecientes a las áreas de salud de los policlínicos docentes Dr Carlos J Finlay y Julián Grimau del municipio de Santiago de Cuba, durante el segundo trimestre de 2016 y dispensarizados en los consultorios médicos correspondientes. Entre los principales resultados sobresalió la frecuencia elevada en los grados 1, 2 y 3 de la estratificación del pie de riesgo y la baja en la categoría sin riesgo, mientras que entre los factores concurrentes predominaron la hiperqueratosis plantar, el hallux valgus, la edad mayor de 40 años, la neuropatía periférica, la enfermedad arterial periférica, el calzado inadecuado y la obesidad

An observational, descriptive and cross-sectional study to determine the stratification of the risky feet and the concurrent factors in 534 patients with diabetes mellitus type 2, belonging to the health areas of Dr Carlos J Finlay and Julián Grimau Teaching polyclinics in Santiago de Cuba municipality was carried out during the second trimester of 2016 and they were classified in their corresponding doctors´ offices. Among the main results there were the increased frequency in the 1, 2 and 3 degrees of the stratification of the risky foot and the low frequency in the category without risk, while among the concurrent factors the plantar hyperkeratosis, the hallux valgus, more than 40 years of age, peripheral neuropathy, the peripheral arterial disease, inadequate shoes and obesity prevailed