RECOMMENDATIONS FOR MANAGEMENT AND PREVENTION OF DFU

Abstract

Foot problems are one of the most expensive and serious complications of diabetes mellitus. Diabetic foot ulcer (DFU) affects approximately 15% of diabetic patients during their lifetime. Strategies such as patient and staff consciousness, prevention and disciplinary treatment of foot ulcers and regular monitoring of patients can reduce amputation percentages by up to 49-85%. Early recognition of DFU can help to reduce the possibility of amputation, possible mortality and improve general life. Blood sugar control, advanced dressings and many more should always be part of DFU management. With appropriate patient and staff education, DFU consciousness and management can lead to better and regular foot care to prevent DFU and its problems. “The most common contributing factors in creating DFU are neuropathy, peripheral artery disease (PAD), deformity and minor trauma. However, when the ulcer appears, other factors usually influence the outcome of the disease. The additional contributing factors are necrosis, gangrene, infection, PAD, advanced age of the patient and other co-morbidities such as end-stage renal disease (ESRD), and heart failure” (Pendsey, 2013).

What is the most effective approach to stimulating wound healing in patients with diabetic ulceration of the foot?

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Recommendations for Management and Prevention of DFU

Estimations show that an average of 7% of the world population are diabetics and it is estimated that this number might increase to 8.3% by the year 2030 (Pendsey, 2013). Diabetes mellitus is a worldwide health threat that has increased rapidly over the last few decades. According to epidemiological research, the figure of patients with DM increased from 30 million cases in 1985, 177 million in 2000, 285 million in 2010, and estimated if the situation continues, more than 360 million people by 2030 will have DM (Flanagan, 2013). One of the common difficulties of DM is DFU. DFU is considered a major source of morbidity and a major cause of hospitalization in patients with diabetes. It can lead to amputation, contamination and even death if not properly taken care of. This nonetheless does not suggest that it cannot be detected early enough and taken care of. With proper awareness of the patients and staff it can be controlled.

Management of DFU

Proper management of DFU can be beneficial to a patient by greatly reducing, delaying or preventing complications such as amputation, infection and even death (Thompson, 2016). It can thus benefit a patient in taking ownership of their illness in order to take necessary steps to prevent complications or the many challenges associated with DFU. The complications of DM should all be treated with no bias or disregard because of the significance they bare to the patient. A couple of measure can be taken to prevent or manage DFU. These include nail and skin care, lipid management, blood pressure control and lifestyle modification. Diabetic patients should ensure that their feet are washed and dried at least once every day with the temperature of the water being less than 37 degrees centigrade. All diabetic patients should use footwear indoors and outdoors always. All diabetic patients should have themselves examined at least once every year for potential of foot related problems. If the patient has demonstrated risk factors then they should be examined as often as every one to six months. A patient might have ulcer or neuropathy without any detection. Absence of signs and symptoms does not always mean that the feet are healthy.

Regular checkup is very useful in this case. Education of patients, family and healthcare providers is an important step in detection of DFU. A patient well aware of the signs and symptoms can detect them early and get medical attention. The same applies to the support system around him. If they are aware of what to look out for, prevention, detection and management of DFU can be avoided or managed. Education should be a gradual process. Making sure that the students understand what to assess and how to respond on those particular cases. Footwear too is a major cause of DFU. Patients need to be very careful while selecting their footwear particularly when deformities are present. Shoes should fit in properly: not too big and not too small. The in sole should fit as well. Ulcer treatment calls for frequent wound checkups, control and maintenance of moist surroundings, using biological active products such as collagen in neuropathic ulcers, and consideration of negative pressure therapy in postoperative wounds. RECOMMENDATIONS FOR MANAGEMENT AND PREVENTION OF DFU

Appropriate self-care knowledge should be given as instructions on how to note the signs and symptoms of infection, which include fever or changes in the wound conditions. Sensory foot examination should be conducted in a calm and quiet environment. The essence is for the patient not to see where and when the examiner applies the filament. The patient is kept actively in the conversation by asking if he/she feels the pressure applied. With two out of three protective sensations present, the patient has no signs or ulceration but if two out of three protective sensations are absent, then the patient is considered to be at risk of ulceration. A turning fork is used in the testing as well. If the patient answers incorrectly at least two of three questions, then he/she is at risk of ulceration but if patient answers correctly two out of three questions, then the patient is clear of the risk. Incorporating an angiosome-directed approach in the lower limb revascularization strategy could be a very useful adjunct to a solely indirect approach, which could increase the likelihood of wound healing. With the limited data currently available, findings appear promising and merit from further investigation. Additional research to form a solid evidence base for this revised strategy in patients with co-morbid diabetes and critical limb ischemia is warranted (Nather, 2018).

While the findings seem promising, further studies pointing toward this direction ought to be performed with thoroughness and utmost accuracy to be tested and delivered. Permissions as well need to be timely and authorized to perform these findings on patients. Further research is required to address this particular problem effectively. However, the set strategies are moving in the right direction as we speak in solving the problem at hand. With advanced means and methods being worked on and proper precautions being taken, awareness of the impacts of DFU is surely on the rise. Precautions to be taken should be taken with no neglect or delay. This should always be observed.

Reference

Acton, A.Q., PhD. (2012). Diabetic Neuropathies- Advances in Research and Treatment: 2012 Edition: ScholarlyBrief. United States: ScholarlyEditions.

Diem, P., Christ, E. & Stettler, C. (2016). Novelties in Diabetes: Endocrine Development. United States: Karger Medical and Scientific Publishers.

Flanagan, M. (2013). Wound Healing and Skin Integrity: Principles and Practice. United States: John Wiley & Sons.

Nather, A. (2008). Diabetic Foot Problems. Singapore: World Scientific.

Pendsey, S. (2013). Contemporary Management of the Diabetic Foot. United States: JP Medical Ltd.

Thompson, Matt. (2016). Oxford Textbook of Vascular Surgery. England: Oxford Press. RECOMMENDATIONS FOR MANAGEMENT AND PREVENTION OF DFU