Glucose Toxic Effects on Granulation Tissue Productive Cells: The Diabetics’ Impaired Healing (original) (raw)
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Wound-healing Abnormalities in Diabetes and New Therapeutic Interventions
US endocrinology, 2007
According to the American Diabetes Association, 7% of the general population and 21% of people over the age of 60 are afflicted with diabetes in the US. One of the most outward and debilitating complications of diabetes is the development of chronic non-healing foot ulcerations, occurring in 15% of diabetics. In its most unfavorable course, diabetic foot ulceration (DFU) leads to amputation in 14-24% of afflicted individuals and is the leading cause of non-traumatic lower-extremity amputation in the US. 1 The national economic burden of DFU and amputation is correspondingly staggering, estimated near US$11 billion in 2001. 2 Traditionally, ischemia, neuropathy, trauma, and infection were considered the culprits of the recurring chronic wound. 3,4 More recently, diabetic impairment of the cutaneous wound-healing process has been recognized as a major contributor to the failure to heal, and wound healing has been appreciated as yet another biological system hindered by the metabolic, vascular, neurological, and inflammatory alterations present in both type 1 and type 2 diabetes. Wound Healing in Diabetes Wound healing requires the well-orchestrated integration of the complex biological and molecular events of cell migration, cell proliferation, and 68
Current Aspects in the Pathophysiology and Treatment of Chronic Wounds in Diabetes Mellitus
BioMed Research International, 2013
Impaired wound healing is a frequent and very severe problem in patients with diabetes mellitus, yet little is known about the underlying pathomechanisms. In this paper we review the biology of wound healing with particular attention to the pathophysiology of chronic wounds in diabetic patients. The standard treatment of diabetic ulcers includes measures to optimize glycemic control as well as extensive debridement, infection elimination by antibiotic therapy based on wound pathogen cultures, the use of moisture dressings, and offloading high pressure from the wound bed. In this paper we discuss novel adjuvant therapies with particular reference to the use of autologous skin transplants for the treatment of diabetic foot ulcers which do not respond to standard care.
Wound healing and treatments for people with diabetic foot ulcers
Diabetes/Metabolism Research and Reviews, 2004
The factors that delay wound healing are multiple and relate both to diabetes and to the effect of its complications. Diabetic foot ulcers readily become chronic, and chronic ulcers have biological properties that differ substantially from acute ones. Much of the available information on the biology of wound healing relates to acute and experimental wounds and may not be directly relevant. It follows that there is limited evidence currently available to underpin protocols for the management of diabetic foot ulcers, or to guide choice of applications and dressings [1]. Nevertheless, it is possible to define certain principles.
Factors Related to Amputation Level and Wound Healing in Diabetic Patients
Acta Ortopédica Brasileira
Objective: There are no specific criteria that define the level of amputation in diabetic patients. The objective of this study was to assess the influence of clinical and laboratory parameters in determining the level of amputation and the wound healing time. Methods: One hundred and thirty-nine diabetic patients were retrospectively assessed. They underwent surgical procedures due to infection and/or ischemic necrosis. Type of surgery, antibiotic use, laboratory parameters and length of hospital stay were evaluated in this study. Results: The most common amputation level was transmetatarsal, occurring in 26 patients (28.9%). The wound healing time increased with statistical significance in individuals undergoing debridement, who did not receive preoperative antibiotics and did not undergo vascular intervention. Higher levels of amputation were statistically related to limb ischemia, previous amputation and non-use of preoperative antibiotics. Conclusion: Patients with minor amputa...
Diabetologia
Aims/hypothesis Our aim was to investigate amputation-free survival in people at high risk for foot ulceration in diabetes ('highrisk foot'), and to compare different subcategories of high-risk foot. Methods Overall, 17,353 people with diabetes and high-risk foot from January 2008 to December 2011 were identified from the Scotland-wide diabetes register (Scottish Care Information-Diabetes: N = 247,278). Participants were followed-up for up to 2 years from baseline and were categorised into three groups: (1) those with no previous ulcer, (2) those with an active ulcer or (3) those with a healed previous ulcer. Participants with prior minor or major amputation were excluded. Accelerated failure time models were used to compare amputation-free survival up to 2 years between the three exposure groups. Results The 2 year amputation-free survival rate in all people with diabetes with high-risk foot was 84.5%. In this study group, 270 people (10.0%) had an amputation and 2424 (90.0%) died during the 2 year follow-up period. People who had active and healed previous ulcers at baseline had significantly lower 2 year amputation-free survival compared with those who had no previous ulcer (both p < 0.0001). The percentage of people who died within 2 years for those with healed ulcer, active ulcer or no baseline ulcer was 22.8%, 16% and 12.1%, respectively. Conclusions/interpretation In people judged to be at high risk of foot ulceration, the risk of death was up to nine times the risk of amputation. Death rates were higher for people with diabetes who had healed ulcers than for those with active ulcers. However, people with active ulcers had the highest risk of amputation.
Delayed wound healing in diabetes: considering future treatments
Diabetes Management, 2011
Diabetic foot ulcers result from multiple risk factors including peripheral neuropathy, arterial insufficiency and foot deformities. Recent investigation has also revealed a chronic wound environment with diminished expression of growth factors and cytokines integral to the wound healing process. Current accepted standard of care for the treatment of diabetic foot ulcerations focuses on periodic debridement of the wound, appropriate topical wound therapy, pressure off-loading and treatment of infection. Owing to increased cost and equivocal effectiveness, topical growth factors, bioengineered living skin equivalents, hyperbaric oxygen therapy and negative pressure wound therapy are proposed as adjuncts to standard of care and may be added to the treatment regimen when healing of the wound has stalled. Other future therapies currently under investigation include stem cell therapy, platelet-rich plasma, extracorporeal shock-wave therapy and laser treatment. These modalities continue to be developed and tested, and may offer promise as effective therapies in the future for the chronic diabetic foot ulcer.
A Comparative Study on Diabetic Foot Ulcers Leading to Amputations
Journal of Postgraduate Medical Institute, 2018
Objective: To determine and compare the frequency of foot ulcers leading to amputations in relation to gender, type and duration of diabetes. Methodology: A descriptive study conducted at three teaching hospitals of Peshawar, from November-2015 to February-2016. Data was collected using convenient sampling technique via semi structured questionnaire. Inclusion cri- teria were diabetic, non-smoker, having no visible deformity other than ulcer or amputation; while critically ill patients, children less than 13 years, gestation- al diabetics and who did not consent upon were excluded. One hundred and twelve diabetics (type 1 & type 2) were included in the study. The collected data were entered and analyzed in SPSS version 23. P values were computed and significance level was set at <0.05. Results: Mean age was 53.55 ±11.58 years. Twenty four males (60%) had foot ulcers and among them, 16 (40%) got their lower leg amputated, whereas 55.5% females had foot ulcers and 24 (33%) among th...