Decreasing incidence of major amputations in people with diabetes

Holstein, P.; Ellitsgaard, Niels; Olsen, Britta; Ellitsgaard, V.

doi:10.1007/s001250051459

Cited by 203 publications

(84 citation statements)

References 14 publications

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“…These data were also almost similar to previous local studies 43,44. Patients’ foot examination and advice regarding foot care from attending physicians will increase patients’ confidence in managing their foot-care practices 20,41…”

Section: Discussionsupporting

confidence: 85%

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Prevalence of diabetic comorbidities and knowledge and practices of foot care among diabetic patients: a cross-sectional study

Abdulghani¹,

Alrajeh²,

Alsalman³

et al. 2018

DMSO

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BackgroundDiabetes mellitus with comorbid complications constitute a major public health problem worldwide. The aim of this study was to evaluate the risk of comorbid complications with glycosylated hemoglobin levels and diabetes duration. Also assessed were patients’ diabetic foot-care knowledge and practices.Patients and methodsThis was a quasiexperimental study. A total of 360 type 2 diabetes mellitus patients were interviewed at a government health care center in Riyadh, Saudi Arabia. Diabetic complications and HbA1c-level data were collected from hospital records. A standard questionnaire was used to assess their diabetic foot-care knowledge and practice.ResultsOf the type 2 diabetes mellitus patients, 32.5% had highly uncontrolled glycosylated hemoglobin (HbA1c) levels (≥8.6%) and 62.8% had had diabetes >10 years. The patients had comorbid complications, such as hypertension (61.4%), dyslipidemia (58.6%), retinopathy (23.3%), heart disease (14.4%), and severe foot complications (3.9%). The majority of highly uncontrolled HbA1c-level patients had retinopathy (OR 8.90, P=0.0001), foot complications (OR 8.09, P=0.0001), dyslipidemia (OR 2.81, P=0.010), and hypertension (OR 2.0, P=0.028) compared to the controlled HbA1c-level (<7%) group. Patients with diabetes >10 years also had higher prevalence of foot complications (OR 2.92, P=0.0001), retinopathy (OR 2.17, P=0.011), and hypertension (OR 1.67, P=0.033). From patient responses, physicians examined only 34.2% of patient feet and 36.7% of patients received physicians advice for foot care. About 70% of patients had knowledge of diabetic foot care; however, only 41.7% of patients always examined their feet, 41.4% washed feet with warm water, 31.4% carefully dried between the toes, and 33.1% were using foot-moisturizing substances.ConclusionThe prevalence of comorbid complications was higher in the Saudi population compared to other international studies. Also, foot-care practice was not satisfactory. Therefore, there is need of improvement and increased awareness among physicians and patients to check regularly for proper care of the diabetic foot to avoid diabetic foot-related complications.

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Section: Discussionsupporting

confidence: 85%

“…A majority of diabetic foot complications can be prevented by patient foot-care practices on a regular basis 41,42. Contrary to this recommendation, in the present study, only 41.7% of diabetic patients’ self-examined their feet.…”

Section: Discussioncontrasting

confidence: 79%

Prevalence of diabetic comorbidities and knowledge and practices of foot care among diabetic patients: a cross-sectional study

Abdulghani¹,

Alrajeh²,

Alsalman³

et al. 2018

DMSO

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“…In our current understanding, there are 3 main types of diabetes which have been confirmed: type 1 diabetes, type 2 diabetes and gestational diabetes. Diabetes is the primary reason for adult blindness, end-stage renal disease (ESRD), gangrene and amputations (22–25). Being overweight, lack of exercise, family history and stress increase the likelihood of developing diabetes.…”

Section: Discussionmentioning

confidence: 99%

Bergapten exerts inhibitory effects on diabetes-related osteoporosis via the regulation of the PI3K/AKT, JNK/MAPK and NF-κB signaling pathways in osteoprotegerin knockout mice

Xue-ju

Zhu

Han

et al. 2016

International Journal of Molecular Medicine

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Diabetes, as a serious metobolic disorder, poses global threat to human health. It is estimated that over 50 million individuals are already affected by diabetes. Currently, diabetes-related osteoporosis has been a research hotspot due to its high incidence rate in older individuals. Osteoprotegerin, as an important protein for the prevention of osteoporosis, has been proven to be key to the suppression of osteoporosis. Hence, the loss of function of osteoprotegerin may promote the development of osteoporosis. Bergapten, as a natural anti-inflammatory and anti-tumor agent isolated from bergamot essential oil, other citrus essential oils, and grapefruit juice, has been proven to have the ability to attenuate a number of metabolic disorders. In view of these findings, in this study, we used a high-fat diet to construct a mouse model of diabetes-related osteoporosis and a mouse model of diabetes-related osteoporosis using osteoprotegerin knockout mice. Enzyme-linked immunosorbent assay (ELISA), qPCR, western blot analysis, immunohistochemical assay, H&E staining, Oil Red O staining, Masson's staining and other biochemical analyses were used to evaluate the related signaling pathways involved in the development of diabetes-related osteoporosis. We also examined the role of osteoprotegerin in the activation of these pathways and in the development of osteoporosis, as well as the protective effects of bergapten against diabetes-related osteoporosis and on the activation of related signaling pathways. Our results revealed that in diabetes-related osteoporosis, the phosphoinositide 3-kinase (PI3K)/AKT, c-Jun N-terminal kinase (JNK)/mitogen-activated protein kinase (MAPK) and nuclear factor-κB (NF-κB) signaling pathways were activated and the expression levels of related indicators were increased. At the same time, osteoprotegerin knockout further promoted the activation of these pathways. By contrast, bergapten exerted effects similar to those of osteoprotegerin. Bergapten exhibited the ability to significantly inhibit RANKL-RANK signaling transduction, and to suppress the activation of the PI3K/AKT, JNK/MAPK and NF-κB signaling pathways, thus protecting trabecular structure and decreasing osteoclastogenic differentiation.

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“…During the last decade, several studies have been published on the decreasing incidence of lower limb amputations (LLAs) in the diabetic population (Holstein et al 2000, Calle-Pascual et al 2001, van Houtum et al 2004, Ekelinen et al 2006, Trautner et al 2007, Larsson et al 2008, Canavan et al 2008). Although the rate of LLA due to peripheral vascular disease in the non-diabetic population has shown a similar trend (Holstein et al 2000, Calle-Pascual et al 2001, Ekelinen et al 2006), unchanged or even increased rates of non-diabetic LLA have been reported (Trautner et al 2007, Canavan et al 2008).…”

mentioning

confidence: 99%

Lower limb amputations in Trondheim, Norway

2010

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Background and purposeIn the city of Trondheim, Norway, diabetic lower-limb amputations accounted for one-third of all lower-limb amputations (LLAs). In an attempt to reduce this rate, a diabetic foot team was established in 1996. We present the incidence of LLA in Trondheim as measured 10 years later.Patients and methodsIn 2004–07, we registered all LLAs performed in Trondheim and then compared the data with previously published data from 1994–1997. From 1996 through 2006, we registered the activity of the diabetic foot team and we also registered the number of vascular procedures performed on citizens of Trondheim from 1998 through 2006.ResultsComparing the two 3-year periods 1994–97 and 2004–07, we observed a decrease in all non-traumatic LLAs. The incidence of diabetic major LLAs per 103 diabetics per year decreased from 4.0 to 2.4, and in patients with peripheral vascular disease we observed a decrease in LLAs from 18 to 12 per 105 inhabitants per year. 5,915 consultations on diabetic subjects were conducted by the diabetic foot team during the period 1996–2006. From 1998 to 2006, the rate of vascular procedures decreased in the non-diabetic population, and was unchanged in diabetic subjects.InterpretationIn the population of Trondheim city there appears to have been a reduction in the rate of vascular obstructive lower-limb disease between the two 3-year periods 1994–97 and 2004–07. In our judgment, the decline in diabetic LLA also reflects better care of the diabetic foot.

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Decreasing incidence of major amputations in people with diabetes

Cited by 203 publications

References 14 publications

Prevalence of diabetic comorbidities and knowledge and practices of foot care among diabetic patients: a cross-sectional study

Prevalence of diabetic comorbidities and knowledge and practices of foot care among diabetic patients: a cross-sectional study

Bergapten exerts inhibitory effects on diabetes-related osteoporosis via the regulation of the PI3K/AKT, JNK/MAPK and NF-κB signaling pathways in osteoprotegerin knockout mice

Lower limb amputations in Trondheim, Norway

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