Diabetic foot ulcers remain a serious medical problem, which is extremely difficult to heal and exhibits a high recurrence rate 1. Thus, it is continuously receiving increased scientific attention, in an effort to improve outcomes 2–4. There is ongoing progress in peripheral arterial disease 1, neuropathy 1, 5, off-loading 1, 2, infection 1, 2, and wound healing 1, 2. The present special issue is devoted to new research in the field of diabetic foot. (https://www.hindawi.com/journals/jdr/2017/3585617/ )
Distal symmetric polyneuropathy is one of the most important predictors of ulcers and amputation. The development of neuropathy can be delayed significantly by maintaining glycemic levels to as near normal as possible. Smoking cessation should be encouraged to reduce the risk of vascular disease complications.
People with neuropathy or evidence of increased plantar pressure may be adequately managed with well-fitted walking shoes or athletic shoes. Patients should be educated on the implications of sensory loss and the ways to substitute other sensory modalities (hand palpation, visual inspection) for surveillance of early problems.
(http://care.diabetesjournals.org/content/26/suppl_1/s78 )
Unfortunately, often patients are in denial of their disease and fail to
take ownership of their illness along with the necessary steps to
prevent complication and to deal with the many challenges associated
with the management of DFU. However, numerous studies have shown that
proper management of DFU can greatly reduce, delay, or prevent
complications such as infection, gangrene, amputation, and even death.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4317316/ )
Gums and diabetes:
Periodontitis is a common chronic inflammatory disease characterised by
destruction of the supporting structures of the teeth (the periodontal
ligament and alveolar bone). It is highly prevalent (severe periodontitis affects 10–15% of adults) and has multiple negative impacts on quality of life. Epidemiological data confirm that diabetes is a major risk factor for periodontitis; susceptibility to periodontitis is increased by approximately threefold in people with diabetes. There is a clear relationship between degree of hyperglycaemia and severity of periodontitis. The mechanisms that underpin the links between these two conditions are not completely understood, but involve aspects of immune functioning, neutrophil activity, and cytokine biology. There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontitis, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycaemic control. Incidences of macroalbuminuria and end-stage renal disease are increased twofold and threefold, respectively, in diabetic individuals who also have severe periodontitis compared to diabetic individuals without severe periodontitis. Furthermore, the risk of cardiorenal mortality (ischaemic heart disease and diabetic nephropathy combined) is three times higher in diabetic people with severe periodontitis than in diabetic people without severe periodontitis. Treatment of periodontitis is associated with HbA1c reductions of approximately 0.4%. Oral and periodontal health should be promoted as integral components of diabetes management.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228943/ )