The current burden of diabetic foot disease

Abstract

Neuropathy and ischaemia are two great pathologies of the diabetic foot which lead to the characteristic features of foot ulceration (neuropathic and ischaemic) and Charcot neuroarthropathy. These can be complicated by infection and eventually may result in amputation (minor or major) and increased mortality. All of these features contribute to considerable clinical and economic burden.Peripheral nerves in the lower limbs are susceptible to different types of damage in patients with diabetes leading to distinctive syndromes. These include symmetrical sensory neuropathy associated with autonomic neuropathy, which advances gradually, and acutely painful neuropathies and mononeuropathies which have a rather acute presentation but usually recover. Ischaemia in the form of peripheral arterial disease is an important contributor to the burden of the diabetic foot. The incidence of atherosclerotic disease is raised in patients with diabetes and its natural history is accelerated. Diabetes causes severe and diffuse disease below-the knee. The lifetime risk of developing a diabetic foot ulcer is between 19% and 34%. Recurrence is common after initial healing; approximately 40% of patients have a recurrence within 1 year after ulcer healing, almost 60% within 3 years, and 65% within 5 years. Charcot neuroarthropathy is characterised by bone and joint destruction on the background of a neuropathy. Its prevalence in diabetes varies from 0.1% to 8%.Infection develops in 50%e60% of ulcers and is the principal pathology that damages diabetic feet. Approximately 20% of moderate or severe diabetic foot infections result in lower extremity amputations. The incidence of osteomyelitis is about 20% of diabetic foot ulcers.Every 20 s a lower limb is amputated due to complications of diabetes. Of all the lower extremity amputations in persons with diabetes, 85% are preceded by a foot ulcer. The mortality at 5 years for an individual with a diabetic foot ulcer is 2.5 times as high as the risk for an individual with diabetes who does not have a foot ulcer. The economic burden exacted on health care systems is considerable and includes direct and indirect costs, with loss of personal earnings and burden to carers. The diabetic foot is a significant contributor to the global burden of disability and reduces the quality of life. It remains a considerable public health problem.

Quantification of Nerve Viscosity Using Shear Wave Dispersion Imaging in Diabetic Rats: A Novel Technique for Evaluating Diabetic Neuropathy

“…Diabetic peripheral neuropathy (DPN) is one of the most common and serious complications of diabetes mellitus (DM), affecting up to 50% of patients with DM [ 1 2 ]. This condition results in various complications, such as sensory and motor dysfunction, lower limb reinfection, ulcers, and amputation, leading to severe disability, decreased quality of life, and even death [ 3 4 ]. Given the high incidence of DPN and the serious consequences of the relevant complications, early diagnosis and treatment are important.…”

Wound Chronicity, Impaired Immunity and Infection in Diabetic Patients

“…[11,102] Compelling evidence describes an infl ammationprone, pro-oxidative and pro-degradative environment in the core of diabetic wounds. [103][104][105][106] Uncontrolled pro-infl ammatory cytokine secretion imposes a pro-catabolic balance in the wound bed that both increases peripheral insulin resistance and reduces injured tissue's anabolic response. [107,108] TNF-α downregulates fi broblast collagen synthesis in diabetic skin and upregulates the synthesis of metalloproteinases by amplifying the wound's proteolytic and pro-degradative profi le.…”

The landscape of diabetic foot in Peru

“…Diabetic Foot (DF) disease is considered as one of the principal complications of DM and it usually has a multifactorial origin. Among its principal contributors are peripheral neuropathy and vascular disease, which can be found in 10% of diabetic type 2 patients and can lead to foot ulceration (2,3). The lifetime risk of developing at least one diabetic foot ulcer is between 15 to 25% (4).…”