Diabetic Foot Ulcer by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9789811576393
Publisher: Springer Singapore

11.2 Risk Factors

In a clinical scenario, when diabetic patients are being dealt with them it is of utmost importance that causal pathway must be considered to the foot ulceration as the best method to prevent DFU formation is the risk factors reduction. The four primary components that must be considered are foot deformities, minor trauma, peripheral arterial disease (PAD), and peripheral neuropathy [12].

11.2.1 Diabetes: Duration and Glycemic Control

Long-standing and uncontrolled glycemic profile of the patient influences the peripheral arterial and neuropathy disease complications’ development by complicated metabolic pathways. The consequences of these complications lead to loss of sensation and ischemia, which alone or in combination may result in foot ulcers [1, 13]. In a study by Vibha et al. [13] including 620 participants with type 2 diabetes mellitus, 70.5% of 321 patients (p < 0.001) with DFS had a history of diagnosed DM for more than 6 years. The duration, as well as high level of glycated hemoglobin, has a strong link with the neuropathy progression and development [1, 14, 15]. It is observed in Diabetes Control and Complications Trials (DCCT) that the HbA1c level’s intensive control effectively reduced the neuropathy incidence in 1441 type 1 diabetes mellitus patients by 60% [16]. In another study on type 2 diabetes mellitus, intensive insulin treatment enhanced vibration perception threshold and nerve conduction velocity than those who were under conventional treatment [17]. However, the UK prospective diabetes study (UKPDS) with 3867 type 2 diabetes patients did not show any glycemic control effect on the neuropathy prevalence [18].

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