ABSTRACT
Diabetes mellitus continues to grow in global prevalence and to consume an increasing amount of health care resources. One of the key areas of morbidity associated with diabetes is the diabetic foot. To improve the care of patients with diabetic foot and to provide an evidence-based multidisciplinary management approach, the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine developed this clinical practice guideline.
Subject(s)
Humans , Diabetic Foot/therapy , Diabetes Mellitus/prevention & control , Diabetes Mellitus/drug therapyABSTRACT
AIMS: Among people with diabetes, 10-25% will experience a foot ulcer. Research has shown that supplementation with arginine, glutamine and ß-hydroxy-ß-methylbutyrate may improve wound repair. This study tested whether such supplementation would improve healing of foot ulcers in persons with diabetes. METHODS: Along with standard of care, 270 subjects received, in a double-blinded fashion, (twice per day) either arginine, glutamine and ß-hydroxy-ß-methylbutyrate or a control drink for 16 weeks. The proportion of subjects with total wound closure and time to complete healing was assessed. In a post-hoc analysis, the interaction of serum albumin or limb perfusion, as measured by ankle-brachial index, and supplementation on healing was investigated. RESULTS: Overall, there were no group differences in wound closure or time to wound healing at week 16. However, in subjects with an albumin level of ≤ 40 g/l and/or an ankle-brachial index of < 1.0, a significantly greater proportion of subjects in the arginine, glutamine and ß-hydroxy-ß-methylbutyrate group healed at week 16 compared with control subjects (P = 0.03 and 0.008, respectively). Those with low albumin or decreased limb perfusion in the supplementation group were 1.70 (95% CI 1.04-2.79) and 1.66 (95% CI 1.15-2.38) times more likely to heal. CONCLUSIONS: While no differences in healing were identified with supplementation in non-ischaemic patients or those with normal albumin, addition of arginine, glutamine and ß-hydroxy-ß-methylbutyrate as an adjunct to standard of care may improve healing of diabetic foot ulcers in patients with risk of poor limb perfusion and/or low albumin levels. Further investigation involving arginine, glutamine and ß-hydroxy-ß-methylbutyrate in these high-risk subgroups might prove clinically valuable.
Subject(s)
Arginine/administration & dosage , Diabetic Foot/physiopathology , Dietary Supplements , Glutamine/administration & dosage , Valerates/administration & dosage , Wound Healing , Adult , Aged , Aged, 80 and over , Ankle Brachial Index , Diabetic Foot/diet therapy , Double-Blind Method , Female , Humans , Male , Middle Aged , Prospective Studies , Treatment OutcomeSubject(s)
Casts, Surgical , Diabetic Foot/therapy , Platelet-Derived Growth Factor/administration & dosage , Humans , Hydrogel, Polyethylene Glycol Dimethacrylate/therapeutic use , Middle Aged , Randomized Controlled Trials as Topic , Recombinant Proteins , Retrospective Studies , Shoes , Statistics, Nonparametric , Wound HealingABSTRACT
The prevalence and clinical types of onychomycosis and diagnostic methods are reviewed in this article. The need for correct identification of the causative organism is emphasized. The use of oral and topical therapeutic agents is outlined, with specific emphasis on relevant research data and potential side effects of these agents. Sections on the potential hazard of nail dust, onychomycosis in HIV-infected patients, and the long-term management of onychomycosis are also included.
