Financial burden of diabetic foot ulcers to world: a progressive topic to discuss always

Raghav, Alok; Khan, Zeeshan Ahmad; Labala, Rajendra Kumar; Ahmad, Jamal; Noor, Saba; Mishra, B.K.

doi:10.1177/2042018817744513

Cited by 214 publications

(152 citation statements)

References 22 publications

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“…This represents a very important health expenditure for the national health systems of such countries. In particular, foot ulcers are associated to diabetes, having a prevalence between 15 and 25%; and the management cost of these ulcers is $9 milliards to $13 milliards in the USA (Raghav et al, 2018).…”

Section: Skin Wound Healingmentioning

confidence: 99%

Extracellular Vesicles Derived From Mesenchymal Stem Cells (MSC) in Regenerative Medicine: Applications in Skin Wound Healing

Casado-Díaz

Quesada‐Gómez

Dorado

2020

Front. Bioeng. Biotechnol.

204

183

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The cells secrete extracellular vesicles (EV) that may have an endosomal origin, or from evaginations of the plasma membrane. The former are usually called exosomes, with sizes ranging from 50 to 100 nm. These EV contain a lipid bilayer associated to membrane proteins. Molecules such as nucleic acids (DNA, mRNA, miRNA, lncRNA, etc.) and proteins may be stored inside. The EV composition depends on the producer cell type and its physiological conditions. Through them, the cells modify their microenvironment and the behavior of neighboring cells. That is accomplished by transferring factors that modulate different metabolic and signaling pathways. Due to their properties, EV can be applied as a diagnostic and therapeutic tool in medicine. The mesenchymal stromal cells (MSC) have immunomodulatory properties and a high regenerative capacity. These features are linked to their paracrine activity and EV secretion. Therefore, research on exosomes produced by MSC has been intensified for use in cell-free regenerative medicine. In this area, the use of EV for the treatment of chronic skin ulcers (CSU) has been proposed. Such sores occur when normal healing does not resolve properly. That is usually due to excessive prolongation of the inflammatory phase. These ulcers are associated with aging and diseases, such as diabetes, so their prevalence is increasing with the one of such latter disease, mainly in developed countries. This has very important socio-economic repercussions. In this review, we show that the application of MSC-derived EV for the treatment of CSU has positive effects, including accelerating healing and decreasing scar formation. This is because the EV have immunosuppressive and immunomodulatory properties. Likewise, they have the ability to activate the angiogenesis, proliferation, migration, and differentiation of the main cell types involved in skin regeneration. They include endothelial cells, fibroblasts, and keratinocytes. Most of the studies carried out so far are preclinical. Therefore, there is a need to advance more in the knowledge about the conditions of production, isolation, and action mechanisms of EV. Interestingly, their potential application in the treatment of CSU opens the door for the design of new highly effective therapeutic strategies.

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Section: Skin Wound Healingmentioning

confidence: 99%

Extracellular Vesicles Derived From Mesenchymal Stem Cells (MSC) in Regenerative Medicine: Applications in Skin Wound Healing

Casado-Díaz

Quesada‐Gómez

Dorado

2020

Front. Bioeng. Biotechnol.

204

183

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“…The diabetic foot specifically remains an area of high cost and morbidity, and has been shown to be a preventable complication of diabetes [2]. Medical costs associated with diabetic foot disease alone in the U.S. ranges from $9-$13 billion annually [3]. Lower extremity amputations are arguably one of the most devastating complications [4,5], with rates significantly higher in adults with diabetes, with an estimated incidence of 195 per 100,000 person-years in adults with diabetes, compared to 23 per 100,000 personyears in their, non-diabetic counterparts [5].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of multidisciplinary care teams in reducing major amputation rate in adults with diabetes: A systematic review & meta-analysis

Albright

Manohar

Murillo

et al. 2020

Diabetes Research and Clinical Practice

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A B S T R A C TAims: To determine the pooled effectiveness of multidiscipinary care teams (MCTs) in reducing major amputation rates in adults with diabetes.Methods: A systematic review and meta-analysis was performed, searching databases MEDLINE, EMBASE, Google Scholar, Cochrane Library, and Clinicaltrials.gov thru October 2018. We included only before-after studies comparing amputation rates before and after the implementation of a MCT for the prevention of major amputation in adults with diabetes. Our primary outcome was relative risk of major amputation. Risk ratios and 95% confidence intervals were calculated using a fixed effects model. Results: Twenty studies met the inclusion criteria. Nine studies were included in the metaanalysis, and eleven were included in a qualitative analysis. Exposure to a MCT resulted in a protective effect ranging from a RR of 0.44 [p-value < 0.00001 (95% CI 0.38, 0.51) I 2 = 67%] to a RR of 0.61 [p-value < 0.0001, (95% CI 0.50, 0.75) I 2 = 0%] after sensitivity analysis, and remained robust in qualitative analysis. Conclusions:Healthcare systems can expect a 39-56% amputation rate reduction after implementing an MCT amputation prevention program. These findings may justify the use of additional resources needed for program implementation by helping healthcare systems predict the anticipated benefit these teams have on ''possible limbs saved".Funding: None.

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“…Diabetic neuropathy (DN) imposes a significant health and economic burden to both the patient and health care providers . DN leads to painful diabetic neuropathy (PDN) in 18% to 65%, erectile dysfunction in 53% to 73%, and diabetic foot ulcers in 2% to 17% of patients with type 2 diabetes mellitus (T2DM). One in four patients with a diabetic foot ulcer is at risk of amputation .…”

Section: Introductionmentioning

confidence: 99%

Prevalence and management of diabetic neuropathy in secondary care in Qatar

Ponirakis

Elhadd

Chinnaiyan

et al. 2020

Diabetes Metabolism Res

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Aims: Diabetic neuropathy (DN) is a "Cinderella" complication, particularly in the Middle East. A high prevalence of undiagnosed DN and those at risk of diabetic foot ulceration (DFU) is a major concern. We have determined the prevalence of DN and its risk factors, DFU, and those at risk of DFU in patients with type 2 diabetes mellitus (T2DM) in secondary care in Qatar.Materials and methods: Adults with T2DM were randomly selected from the two National Diabetes Centers in Qatar. DN was defined by the presence of neuropathic symptoms and a vibration perception threshold (VPT) ≥ 15 V. Participants with a VPT ≥ 25 V were categorized as high risk for DFU. Painful DN was defined by a DN4 score ≥4. Logistic regression analysis was used to identify predictors of DN.Results: In 1082 adults with T2DM (age 54 ± 11 years, duration of diabetes 10.0 ± 7.7 years, 60.6% males), the prevalence of DN was 23.0% (95% CI, 20.5%-25.5%) of whom 33.7% (95% CI, 27.9%-39.6%) were at high risk of DFU, and 6.3% had DFU; 82.0% of the patients with DN were previously undiagnosed. The prevalence of DN increased with age and duration of diabetes and was associated with poor glycaemic control (HbA 1c ≥ 9%) AOR = 2.1 (95% CI, 1.3-3.2), hyperlipidaemia AOR = 2.7 (95% CI, 1.5-5.0), and hypertension AOR = 2.0 (95% CI, 1.2-3.4). Conclusions:Despite DN affecting 23% of adults with T2DM, 82% had not been previously diagnosed with one-third at high risk for DFU. This argues for annual screening and identification of patients with DN. Furthermore, we identify hyperglycaemia, hyperlipidaemia, and hypertension as predictors of DN. K E Y W O R D S diabetic neuropathy, painful diabetic neuropathy, diabetic foot ulceration, type 2 diabetes mellitus

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Financial burden of diabetic foot ulcers to world: a progressive topic to discuss always

Cited by 214 publications

References 22 publications

Extracellular Vesicles Derived From Mesenchymal Stem Cells (MSC) in Regenerative Medicine: Applications in Skin Wound Healing

Extracellular Vesicles Derived From Mesenchymal Stem Cells (MSC) in Regenerative Medicine: Applications in Skin Wound Healing

Effectiveness of multidisciplinary care teams in reducing major amputation rate in adults with diabetes: A systematic review & meta-analysis

Prevalence and management of diabetic neuropathy in secondary care in Qatar

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