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Related Concept Videos

Diabetic Foot Ulcer01:31

Diabetic Foot Ulcer

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Definition A diabetic foot ulcer (DFU) is a chronic, non-healing wound that develops in individuals with diabetes. It typically occurs on pressure-bearing areas such as the heel, metatarsal heads, or hallux, and carries a high risk of infection and amputation.Pathophysiology • The development of DFUs can be explained by four interconnected mechanisms: neuropathy, ischemia, infection, and impaired wound healing. • Neuropathy is the most common factor. Sensory...
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Diabetic Neuropathy01:22

Diabetic Neuropathy

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DefinitionDiabetic neuropathy is nerve damage caused by long-standing diabetes mellitus. It results directly from prolonged high blood sugar levels.PathophysiologyThe pathophysiology of diabetic neuropathy involves both metabolic and vascular disturbances triggered by chronic hyperglycemia.Metabolic injury: Elevated glucose levels activate the polyol pathway within nerve cells, leading to the accumulation of sorbitol and fructose. This increases oxidative stress, disrupts normal nerve...
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Diabetic Retinopathy01:27

Diabetic Retinopathy

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DefinitionDiabetic retinopathy is a microvascular complication of diabetes affecting the retinal blood vessels.Risk FactorsDiabetic retinopathy is present in almost all individuals with type 1 diabetes and more than 60% of those with type 2 diabetes after two decades of disease.The risk increases with poor glycemic control, hypertension, dyslipidemia, smoking, pregnancy, and puberty.Although cataracts and glaucoma are also more frequent in people with diabetes, retinopathy remains the leading...
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Diabetes: Management and Pharmacotherapy01:15

Diabetes: Management and Pharmacotherapy

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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
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Complications of Diabetes Mellitus01:22

Complications of Diabetes Mellitus

44
Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia due to insulin deficiency, resistance, or both. Prolonged hyperglycemia disrupts metabolic homeostasis and leads to acute and chronic complications.Acute ComplicationsAcute complications result from sudden metabolic imbalance.Diabetic ketoacidosis (DKA) mainly appears in type 1 diabetes but may also develop in type 2 diabetes, particularly under extreme stress. It arises from severe insulin deficiency,...
44
Diabetes: Symptoms, Diagnosis, and Complications01:15

Diabetes: Symptoms, Diagnosis, and Complications

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For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
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Evaluating the Function of the Foot Core System in the Elderly
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The diabetic foot: a review.

J B Ricco1, L Thanh Phong, F Schneider

  • 1Vascular Surgery Department, Jean Bernard Hospital University of Poitiers, Poitiers, France - jeanbaptistericco@gmail.com.

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Summary

Diabetic foot ulcers (DFU) often involve vascular issues. Early diagnosis, vascular testing, and a multidisciplinary approach can prevent amputations in diabetic patients.

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Area of Science:

  • Vascular Surgery
  • Diabetology
  • Podiatry

Background:

  • Diabetic foot ulceration (DFU) is a common diabetes complication, often initiated by neuropathy and ischemia, with infection as a frequent consequence.
  • Vascular impairment is a key factor in DFU, with toe pressure >55 mmHg generally indicating healing potential and transcutaneous oxygen pressure (TcPO2) <30 mmHg predicting non-healing.
  • DFU is associated with significant mortality and morbidity, and lower limb amputation rates are substantially higher in diabetic patients.

Purpose of the Study:

  • To review the management of diabetic foot ulcers, focusing on vascular assessment and intervention strategies.
  • To highlight the importance of early diagnosis and multidisciplinary care in preventing amputations.
  • To discuss the indications for surgical intervention and amputation in complex DFU cases.

Main Methods:

  • Review of existing literature on diabetic foot ulceration, vascular impairment, and treatment outcomes.
  • Analysis of clinical findings and diagnostic criteria, including toe pressure and TcPO2 measurements.
  • Evaluation of endovascular versus bypass procedures and indications for major amputation.

Main Results:

  • Endovascular treatments are preferred over bypass when outcomes are comparable, although bypass shows better mid-term patency rates without affecting limb salvage.
  • Deep infections, uncontrolled abscesses, gangrene, or necrotising fasciitis necessitate prompt surgical intervention including debridement and revascularisation.
  • Early referral, non-invasive vascular testing, imaging, and timely intervention are critical for improving DFU healing and preventing amputations.

Conclusions:

  • DFU management requires a comprehensive approach, considering vascular status, infection control, and patient factors.
  • Prompt surgical intervention and revascularisation are vital for 'foot-at-risk' patients.
  • A multidisciplinary approach and early diagnosis can significantly reduce the high rates of lower limb amputations in diabetic patients.