Podiatric care from diabetologists point of view.

Scoring for the risk of Diabetic foot syndrome (DFS) should be performed regularly in each patient with diabetes mellitus (DM). Patients at risk for DFS should be followed by diabetologists, those with moderate and severe risk for the development of DFS or those with DFS in remission should be already followed by podiatrists. The aim of our study was to determine the extent of DFS risk screening procedures, dispensary care of patients at risk for DFS and treatment of patients with newly developed DFS in diabetes clinics in the Czech Republic. METHODS: To find out the study data, we prepared in cooperation with the ČDS ČLS JEP Committee a questionnaire survey for outpatient diabetology specialists. RESULTS: The questionnaire was completed by 57% (76/135) of diabetologists. Most of them dispensary approximately 1000- 2000 patients with DM. Their feet are checked by 98.7% of diabetologists (1.6 ± 0.8 times a year on average). Screening for the risk of DFS (13024) is performing in less than 100 patients by 74.3% of diabetologists, in 100-200 patients by 14.9% and in more than 200 patients by 10.8% of diabetologists. 77% of respondents are able to examine neuropathy, the rest send their patients to neurologists, peripheral arterial disease is evaluated by only 47.3% of diabetologists (35.3% of them use some form of instrumental examination), others (48.6%) send patients to angiologists, 4.1% of diabetologists do not examine PAD at all). Based on the assessed findings, more than half of the respondents (50.7%) perform scoring for the risk of DFS, but 1/5 of outpatient diabetologists do not know how the scoring is performed. If colleagues find a patient at a risk for DFS, they usually follow him/her by themselves (64.4%), in 24.6% of cases they send the patient immediately to podiatry or surgery (11%). If a patient with a new DFS comes at diabetology clinic, 72.6% of diabetologists are able to prescribe off-loading, 60.3% antibiotics, 47.9% local therapy. Only 52.1% of diabetologists send a patient with a new DFS to outpatient foot clinic, 39.7% to surgery, the rest of them elsewhere. CONCLUSION: Based on the questionnaire survey results, the screening of DFS is currently severely undersized in outpatient diabetology clinics, it is sufficiently performed only by 11% of diabetologists. Only 16% of diabetologists perform some form of non-invasive diagnostic procedures detecting peripheral arterial disease, neuropathy examinations are more common. If a diabetologist meet a patient with newly developed DFS, he/she is able to prescribe off-loading or antibiotics, but only half of the diabetologists send the patient to outpatient foot clinic, probably due to a lack of them or their overload.

The association of masked hypertension in treated type 2 diabetic patients with carotid artery IMT.

OBJECTIVES: To evaluate the association of masked hypertension (MH) in treated type 2 diabetic patients without history of cardiovascular disease with carotid artery target organ damage. METHODS: Sixty-four type 2 diabetic patients treated for hypertension with office BP below 140/90 mm Hg were examined by 24-h BP monitoring and carotid sonography. MH was diagnosed if daily mean ambulatory BP was >or=135/85 mm Hg. The association of MH with carotid artery parameters was evaluated. RESULTS: The average age of patients was 62+/-5 years. Twenty-four patients had MH (37.5%). Carotid artery IMT was 0.74+/-0.08 mm in patients with MH and 0.69+/-0.06 mm without MH (p=0.03). The distensibility of common carotid artery was 0.24+/-0.07 mmHg(-1) in patients with MH and 0.29+/-0.1mm Hg(-1) without MH (p=0.14). After adjustment for age, gender, smoking, duration of diabetes, BMI and clinic blood pressure (BP) values the association of MH with carotid artery IMT was sustained. CONCLUSION: Masked hypertension in treated type 2 diabetic patients is associated with carotid artery IMT.

Positive effect of long-term tailored physical activity therapy on diabetes mellitus management in an obese type 2 diabetic patient.

The case history of a 44-year-old, severely obese Caucasian man with serious decompensation of diabetes and subsequent withdrawal of high-dose insulin is reported. Insulin was withdrawn after 5 years of continuous therapy and the patient was treated for 6 months with diet, individualized physical therapy and oral antidiabetic drugs from the group of insulin sensitizers. Six months later, oral antidiabetics were discontinued for low blood glucose levels, and the treatment was limited to therapeutic life style changes. After insulin withdrawal, the patient's condition markedly improved: he showed better diabetes control, decrease in insulin resistance, weight loss, reduced BMI, reduced waist circumference, sagittal abdominal diameter and body fat, increased fitness level, normalized blood pressure and decreased heart rate at rest.