12. Retinopathy, Neuropathy, and Foot Care:<i>Standards of Care in Diabetes—2023</i>

ElSayed, Nuha A.; Aleppo, Grazia; Aroda, Vanita R.; Bannuru, Raveendhara R.; Brown, F. C.; Bruemmer, Dennis; Collins, Billy; Gibbons, Christopher H.; Giurini, John M.; Hilliard, Marisa E.; Isaacs, Diana; Johnson, Eric L.; Kahan, Scott; Khunti, Kamlesh; León, José; Lyons, Sarah K.; Perry, Mary Lou; Prahalad, Priya; Pratley, Richard E.; Seley, Jane Jeffrie; Stanton, Robert C.; Sun, Jennifer K.; Gabbay, Robert A.

doi:10.2337/dc23-s012

Cited by 107 publications

(69 citation statements)

References 110 publications

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“…Current screening practices are region specific, but the position statement by the American Diabetes Association (ADA) and the ADA evidence-based standards of care in diabetes guideline provide comprehensive guidance [ 8 , 62 ]. The ADA recommends that medical history and comprehensive foot examination be used to screen for diabetic peripheral neuropathy at time of diagnosis for patients with T2DM and five years after diagnosis for patients with T1DM.…”

Section: Resultsmentioning

confidence: 99%

“…The ADA recommends that medical history and comprehensive foot examination be used to screen for diabetic peripheral neuropathy at time of diagnosis for patients with T2DM and five years after diagnosis for patients with T1DM. Furthermore, patients should be reassessed at least annually regardless of DM type using 10-g Semmes–Weinstein monofilament evaluation (SWME) and at least one other clinical assessment such as vibration perception, pinprick, temperature perception, or ankle reflexes [ 62 ].…”

Section: Resultsmentioning

confidence: 99%

“…The ADA does not recommend assessment of sudomotor function during clinical evaluation of diabetic peripheral neuropathy [ 62 ]. Instead, pinprick and temperature sensation are recommended for assessment of small nerve fiber function.…”

Section: Resultsmentioning

confidence: 99%

“…The ADA proposes a comprehensive scheme for classifying diabetic neuropathy into diffuse neuropathy; mononeuropathy; and radiculopathy [8] twenty-first century AD Development and implementation of comprehensive diabetic foot prevention programs gains momentum around the world Current screening practices are region specific, but the position statement by the American Diabetes Association (ADA) and the ADA evidence-based standards of care in diabetes guideline provide comprehensive guidance [8,62]. The ADA recommends that medical history and comprehensive foot examination be used to screen for diabetic peripheral neuropathy at time of diagnosis for patients with T2DM and five years after diagnosis for patients with T1DM.…”

Section: Yearmentioning

confidence: 99%

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Screening for diabetic peripheral neuropathy in resource-limited settings

Nkonge

2023

Diabetol Metab Syndr

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Background Diabetic neuropathy is the most common microvascular complication of diabetes mellitus and a major risk factor for diabetes-related lower-extremity complications. Diffuse neuropathy is the most frequently encountered pattern of neurological dysfunction and presents clinically as distal symmetrical sensorimotor polyneuropathy. Due to the increasing public health significance of diabetes mellitus and its complications, screening for diabetic peripheral neuropathy is essential. Consequently, a review of the principles that guide screening practices, especially in resource-limited clinical settings, is urgently needed. Main body Numerous evidence-based assessments are used to detect diabetic peripheral neuropathy. In accordance with current guideline recommendations from the American Diabetes Association, International Diabetes Federation, International Working Group on the Diabetic Foot, and National Institute for Health and Care Excellence, a screening algorithm for diabetic peripheral neuropathy based on multiphasic clinical assessment, stratification according to risk of developing diabetic foot syndrome, individualized treatment, and scheduled follow-up is suggested for use in resource-limited settings. Conclusions Screening for diabetic peripheral neuropathy in resource-limited settings requires a practical and comprehensive approach in order to promptly identify affected individuals. The principles of screening for diabetic peripheral neuropathy are: multiphasic approach, risk stratification, individualized treatment, and scheduled follow-up. Regular screening for diabetes-related foot disease using simple clinical assessments may improve patient outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Yearmentioning

confidence: 99%

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Screening for diabetic peripheral neuropathy in resource-limited settings

Nkonge

2023

Diabetol Metab Syndr

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“…Diabetes mellitus is a complex metabolic disease characterized by a chronic state of hyperglycemia [ 181 ]. Although the impaired function of the pancreatic islets might be relevant in its etiology, other tissues are affected and may present complications in uncontrolled disease [ 182 ]. Diabetes can be generally classified into different categories with distinct clinical features.…”

Section: Vanadium Effects On Lipid Peroxidation and Disease Processesmentioning

confidence: 99%

Biological Consequences of Vanadium Effects on Formation of Reactive Oxygen Species and Lipid Peroxidation

Aureliano

Sousa‐Coelho

Dolan

et al. 2023

IJMS

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Lipid peroxidation (LPO), a process that affects human health, can be induced by exposure to vanadium salts and compounds. LPO is often exacerbated by oxidation stress, with some forms of vanadium providing protective effects. The LPO reaction involves the oxidation of the alkene bonds, primarily in polyunsaturated fatty acids, in a chain reaction to form radical and reactive oxygen species (ROS). LPO reactions typically affect cellular membranes through direct effects on membrane structure and function as well as impacting other cellular functions due to increases in ROS. Although LPO effects on mitochondrial function have been studied in detail, other cellular components and organelles are affected. Because vanadium salts and complexes can induce ROS formation both directly and indirectly, the study of LPO arising from increased ROS should include investigations of both processes. This is made more challenging by the range of vanadium species that exist under physiological conditions and the diverse effects of these species. Thus, complex vanadium chemistry requires speciation studies of vanadium to evaluate the direct and indirect effects of the various species that are present during vanadium exposure. Undoubtedly, speciation is important in assessing how vanadium exerts effects in biological systems and is likely the underlying cause for some of the beneficial effects reported in cancerous, diabetic, neurodegenerative conditions and other diseased tissues impacted by LPO processes. Speciation of vanadium, together with investigations of ROS and LPO, should be considered in future biological studies evaluating vanadium effects on the formation of ROS and on LPO in cells, tissues, and organisms as discussed in this review.

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Diabetic Foot Ulcers

Armstrong

Tan

Boulton

et al. 2023

JAMA

295

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ImportanceApproximately 18.6 million people worldwide are affected by a diabetic foot ulcer each year, including 1.6 million people in the United States. These ulcers precede 80% of lower extremity amputations among people diagnosed with diabetes and are associated with an increased risk of death.ObservationsNeurological, vascular, and biomechanical factors contribute to diabetic foot ulceration. Approximately 50% to 60% of ulcers become infected, and about 20% of moderate to severe infections lead to lower extremity amputations. The 5-year mortality rate for individuals with a diabetic foot ulcer is approximately 30%, exceeding 70% for those with a major amputation. The mortality rate for people with diabetic foot ulcers is 231 deaths per 1000 person-years, compared with 182 deaths per 1000 person-years in people with diabetes without foot ulcers. People who are Black, Hispanic, or Native American and people with low socioeconomic status have higher rates of diabetic foot ulcer and subsequent amputation compared with White people. Classifying ulcers based on the degree of tissue loss, ischemia, and infection can help identify risk of limb-threatening disease. Several interventions reduce risk of ulcers compared with usual care, such as pressure-relieving footwear (13.3% vs 25.4%; relative risk, 0.49; 95% CI, 0.28-0.84), foot skin measurements with off-loading when hot spots (ie, greater than 2 °C difference between the affected foot and the unaffected foot) are found (18.7% vs 30.8%; relative risk, 0.51; 95% CI, 0.31-0.84), and treatment of preulcer signs. Surgical debridement, reducing pressure from weight bearing on the ulcer, and treating lower extremity ischemia and foot infection are first-line therapies for diabetic foot ulcers. Randomized clinical trials support treatments to accelerate wound healing and culture-directed oral antibiotics for localized osteomyelitis. Multidisciplinary care, typically consisting of podiatrists, infectious disease specialists, and vascular surgeons, in close collaboration with primary care clinicians, is associated with lower major amputation rates relative to usual care (3.2% vs 4.4%; odds ratio, 0.40; 95% CI, 0.32-0.51). Approximately 30% to 40% of diabetic foot ulcers heal at 12 weeks, and recurrence after healing is estimated to be 42% at 1 year and 65% at 5 years.Conclusions and RelevanceDiabetic foot ulcers affect approximately 18.6 million people worldwide each year and are associated with increased rates of amputation and death. Surgical debridement, reducing pressure from weight bearing, treating lower extremity ischemia and foot infection, and early referral for multidisciplinary care are first-line therapies for diabetic foot ulcers.

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12. Retinopathy, Neuropathy, and Foot Care:Standards of Care in Diabetes—2023

Cited by 107 publications

References 110 publications

Screening for diabetic peripheral neuropathy in resource-limited settings

Screening for diabetic peripheral neuropathy in resource-limited settings

Biological Consequences of Vanadium Effects on Formation of Reactive Oxygen Species and Lipid Peroxidation

Diabetic Foot Ulcers

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