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Diabetic Foot Complications

As we read through the literature we get a view on the severity of diabetic foot ulcerations. Copy/pasting from the articles below we get the following picture.

Chronic nonhealing neuropathic foot ulcers occur in approximately 15% of patients with diabetes. In 2011, there were an estimated 366,000,000 adults with diabetes. Worldwide global projections indicate that this figure will increase to 552,000,000 by 2030. It is estimated (2003) that 24.4% of the total health care expenditure among diabetic population is related to foot complications and the total cost of treating diabetic foot complications is approaching 11 billion USD in USA and 456 million USD in UK. Wound care in general costs 2-5% of your national health expenditure. (billions) Hospital-based studies have shown that mortality rates in individuals with diabetic foot ulcers are about twice those observed in individuals with diabetes without foot ulcers.

To sum it up, diabetic foot lesions involve a lot of people, a lot of suffering, a lot of money and time and they “have legs for breakfast” and may “kill you overnight”.

So what do we do about it… not much!

Despite the effort of many dedicated clinicians who, we cannot thank them enough, take up the Sisyphean task of point out the importance of prevention, monitoring and treatment we still are stuck with an ever increasing number of diabetics suffering from ulcers. Some policy makers even cut cost on this issue with dramatic effects.  The number of diabetic foot ulcers can be reduced significantly. Therefore it is today still shocking to see how many “chronic” ulcers heal within 7 weeks in the right hands.

Just to make sure; anyone dealing with diabetic ulcers is supposed to know and apply the national and international guidelines;  http://iwgdf.org/

Make no mistake, diabetic ulcers can be very hard to treat for many reasons and some will never heal. The problems “behind the ulcers” are daunting and need to be solved. Nevertheless, as often, the first steps to treat a foot ulcus are straightforward.

First and best is to make sure someone who has a diabetic foot wound gets basic wound care. It is not rocket science but for some reason the average medical professional is having a tough time to set up prevention and often is not able to deliver level 1 and 2 wound care.

What is level 1 and 2 wound care?

Level 1 and 2 wound care are on both sides of the wound healing equilibrium.

A healthy person can handle most wounds without much ado (Vigor), level 1 is aimed at increasing Vigor. If the wound is large or complicated the body will need help (Severity). Level 2 is aimed at reducing severity.

Ergo, the equilibrium:        Balans-EN

Level 1 is to make sure the patient has the best possible health under the circumstances: 1. take care of diabetes regulation 2. remove stress (and get some sleep) 3. eat properly and 4 mobilize as much as you can.

Level 2 is debride the wound at least twice a week (debriding = remove anything which is not living cells (debriding is not mopping a wound with a gauze)) and secondly apply enough pressure to the wound to handle oedema. That is it.

If you do not know how to debride a wound properly or are not able to; transfer the patient to someone who is better able to treat the ulcer.

If the wound does not start healing in 2 weeks, step up your effort or even better, transfer the patient to someone who is better able to treat the ulcer.

Once healed, step up prevention and monitoring to the max.

 

http://www.jci.org/articles/view/32169/pdf

http://poi.sagepub.com/content/39/1/29.abstract  (Thank you Lian)

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0124446

http://care.diabetesjournals.org/content/37/9/e196.extract

(Debriding is a medical intervention which only skilled medical professionals are allowed to do. A non-healing wound has to be seen by a specialised doctor or nurse.)

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