Complications of diabetes: screening for retinopathy and management of foot ulcers

Abstract

This paper is based on EVective Health Care, volume 5, number 4, 1 which is based on two systematic reviews undertaken to inform national clinical practice guidelines for type 2 diabetes.2 3 The first part of the article looks at screening for diabetic retinopathy and the second at the prevention and treatment of diabetic foot ulcers.Two of the most common complications of diabetes are visual problems caused by retinopathy, and problems with the feet, particularly persistent ulcers. These result from microvascular and macrovascular complications, often exacerbated by chronically raised blood glucose levels. Around 2% of the UK population are believed to have diabetes, of whom perhaps 200 000 have type 1 (insulin dependent) diabetes, and more than a million have type 2 (non-insulin dependent) diabetes.

Multifaceted support to improve clinical decision making in diabetes care: a randomized controlled trial in general practice

“…The intervention resulted in statistically significant improvement for the indicators pertaining to foot examination and eye examination. Foot care reduces amputation rates and early treatment of retinopathy prevents blindness [13 ]. The positive effect on foot examination confirms the results of a British trial in general practice evaluating the implementation of an integrated diabetic footcare model with use of educational practice visits [ 14 ].…”

Diagnosis and management of diabetic neuropathy

“…Currently, in the type 2 diabetes population, lower-limb ulceration, recurrent ulceration, and amputation remain frequent events with incidence rates as high as 3.0%, 25%, and 0.8% per year, respectively [59]. A recent estimate of the lifetime prevalence of foot ulceration is 15% [6]. It has been demonstrated that a program of intensive weekly multidisciplinary clinic visits with chiropody, education, and use of proper hygiene, hosiery, and protective shoes in high-risk type 2 diabetic patients reduces the amputation rate threefold when compared with more standard care [6].…”

“…A recent estimate of the lifetime prevalence of foot ulceration is 15% [6]. It has been demonstrated that a program of intensive weekly multidisciplinary clinic visits with chiropody, education, and use of proper hygiene, hosiery, and protective shoes in high-risk type 2 diabetic patients reduces the amputation rate threefold when compared with more standard care [6]. In this study, high-risk patients were defined as those with foot deformity, or a history of foot ulceration, significant vascular disease, or significant neuropathic disease.…”

“…The generalized neuropathies associated with diabetes represent insidious and progressive processes for which the pathologic severity is poorly linked with the development of symptoms [1,2]. Peripheral neuropathy, formally termed diabetic sensorimotor polyneuropathy (DSP), is the most common neuropathy in the developed world and the component cause that initiates the pathophysiologic pathway to leg ulceration and amputation [3][4][5][6]. In a multifactorial process involving the environmental event of minor trauma, neuropathy potentiates the ulcerating skin lesion, intercurrent faulty healing, and gangrene.…”

Improving care for people with diabetes

“…Melville et al 7 found that multidisciplinary interventions such as education to increase patients' knowledge about foot care, podiatry, and therapeutic shoes can improve the condition of the feet and help to reduce ulcer and amputation rates. Various treatments are used for diabetic foot ulcers but the evidence for their eVectiveness is poor.…”