Regional differences in risk factors and clinical presentation of diabetic foot lesions

Morbach, Stephan; Lutale, Janet; Viswanathan, Vijay; Möllenberg, Jörg; Ochs, Hermann R.; Rajashekar, Somarouthu; Ramachandran, Ambady; Abbas, Z. G.

doi:10.1046/j.1464-5491.2003.01069.x

Cited by 91 publications

(93 citation statements)

References 15 publications

(18 reference statements)

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“…While risk factors for ulceration appear to be similar among European countries [103], differences do exist between European and African and Asian countries, with vascular disease being less common in developing countries [104]. In view of the global problem of diabetic foot disease, the International Working Group on the Diabetic Foot was created about 10 years ago, which later became an official consultative section of the International Diabetes Federation in 2001.…”

Section: International Developmentsmentioning

confidence: 99%

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

2004

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Diabetic foot ulceration represents a major medical, social and economic problem all over the world. While more than 5% of diabetic patients have a history of foot ulceration, the cumulative lifetime incidence may be as high as 15%. Ethnic differences exist in both ulcer and amputation incidences, with both being less common in patients of Indian subcontinent origin living in the UK. Foot ulceration results from the interaction of several contributory factors, the most important of which is neuropathy. With respect to the management of acute Charcot neuroarthropathy in diabetes, recent studies suggest that bisphosphonates reduce disease activity as judged not only by differences in skin temperature, but also by assessing markers of bone turnover. The use of the total-contact cast is demonstrated in the treatment of acute Charcot feet and of plantar neuropathic ulcers. Histological evidence suggests that pressure relief results in chronic foot ulcers changing their morphological appearance by displaying some features of an acute wound. Thus, repetitive stresses on the insensate foot appear to play a major role in maintaining ulcer chronicity. It is hoped that increasing research activity in foot disease will ultimately result in fewer ulcers and less amputation in diabetes.

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Section: International Developmentsmentioning

confidence: 99%

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

2004

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mentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12][13][14][15][16][17] Some complications of diabetes include blindness, renal failure, and cardiovascular complications, but complications connected to the foot are related to the highest rates of morbidity and mortality. [5][6][7][8][9][10][11][12][13][14][15][16][17] Complications of the foot like septic foot can be very serious and extremely costly. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Among all the lower limb nontraumatic amputations performed across the globe, 40%-60% are performed in patients with diabetes.…”

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confidence: 99%

Managing the diabetic foot in resource-poor settings: challenges and solutions

Abbas¹

2017

CWCMR

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Diabetes mellitus is one of the most common noncommunicable diseases globally. In Africa, rates of diabetes are increasing, so there is a parallel increase of foot complications. Peripheral neuropathy is the main risk factor for foot ulceration in people with diabetes in developing nations, but peripheral arterial disease is also increasing in number owing to the change in lifestyle and increasing urbanization. Ulceration arising from peripheral neuropathy, peripheral arterial disease, and trauma are highly susceptible to secondary infection and gangrene, and are hence associated with increased morbidity and mortality. Government funding is very limited in many developing countries, and diabetes and its complications impose a heavy burden on health services. In particular, the outcomes of foot complications are often poor, and this is the result of various factors including lack of awareness of the need for foot care among patients, relatives, and health care providers; relatively few professionals with an interest in the diabetic foot and with the training to provide specialist treatment; nonexistent podiatry services; long distances for patients to travel to the clinic; delays among patients in seeking medical care, or the late referral of patients for specialist opinion; and lack of the awareness of the importance of a team approach to care, and the lack of training programs for health care professionals. Many of these can, however, potentially be tackled without exorbitant spending of financial resources. Cost-effective educational efforts should be targeted at both health care workers and patients. These include implementation of sustainable training programs for health care professionals with a special interest in foot care and focusing to disseminate the foot care information, on the prevention and management of the diabetic foot, to other health care professionals and to patients. The Step by Step foot program is an educational program that was first carried out in Tanzania and India. In conclusion, the only way to move forward in developing countries is educational programs on prevention and management of the diabetic foot. An interdisciplinary team approach is needed, and not multidisciplinary, for the management of the diabetic foot. Patients presenting early at a less severe stage will definitely lead to reduction in morbidity and death rates.

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“…have reported prevalences varying from 4-15%, the higher rates seen in patients with a longer disease duration (Table 4) [23,25,[74][75][76][77][78][79][80][81]. Studies from Pakistan have shown a higher prevalence, however these studies used only low ankle brachial index (ABI<0.9) as the diagnostic criterion for PVD.…”

Section: Reviews | 13mentioning

confidence: 99%

“…Studies from Pakistan have shown a higher prevalence, however these studies used only low ankle brachial index (ABI<0.9) as the diagnostic criterion for PVD. In a multicentric study done in clinics in India, Tanzania and Germany, the prevalence of PVD was seen to be lower among Indian patients with diabetic foot ulcers compared to German patients (13% vs. 48%, respectively) [79]. In a clinic based study (n = 597, newly diagnosed patients with diabetes) in the suburbs of the Colombo area 4.8% patients had intermittent claudication and 1.8% had lower extremity amputation (LEA) [82].…”

Section: Reviews | 13mentioning

confidence: 99%

Epidemiology of Macrovascular Complications of Diabetes in South Asians and Comparison with Other Ethnicities

Gupta

Misra²

2016

ICFJ

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South Asians have been shown to have increased abdominal adiposity, visceral fat, low muscle mass and subclinical inflammation, all of which make them prone to diabetes and its macrovascular complications. Diabetes is the most important risk factor for coronary artery disease in South Asia and South Asians with diabetes have a higher prevalence of CAD than Caucasians. Similar trend has been seen with stroke and cerebrovascular disease.. Importantly peripheral vascular disease and diabetic foot occur less frequently in South Asians compared to Caucasians. In addition, erectile dysfunction is emerging as an important complication of diabetes in South Asians and its association with cardiovascular disease is being recognised increasingly.

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Regional differences in risk factors and clinical presentation of diabetic foot lesions

Cited by 91 publications

References 15 publications

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

Managing the diabetic foot in resource-poor settings: challenges and solutions

Epidemiology of Macrovascular Complications of Diabetes in South Asians and Comparison with Other Ethnicities

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