Diabetes - NAD Nutritional Support: The burden of diabetic foot ulcers.

The burden of diabetic foot ulcers.
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Diabetes on 26/03/2011 12:38:00

Results of etiologic studies suggest that hyperglycemia induces diabetes-related
complications through sorbitol accumulation and protein glycation

Lower extremity ulcers represent a major concern for patients with diabetes and
for those who treat them, from both a quality of life and an economic
standpoint. Studies to evaluate quality of life have shown that patients with
foot ulcers have decreased physical, emotional, and social function. Analyses of
economic impact have shown
(1) the majority of costs occur in the inpatient setting,
(2) a lack of financial benefit when comparing primary amputation with an
aggressive approach to limb salvaging including vascular reconstruction, and
(3) private insurance provides greater reimbursement for inpatient care than
does Medicare.
Results of etiologic studies suggest that hyperglycemia induces diabetes-related
complications through sorbitol accumulation and protein glycation, and the
resultant nerve damage manifests as peripheral neuropathy, which predisposes to
ulcer development.
Patients with diabetes also have an increased incidence of peripheral vascular
disease, impaired wound healing, and decreased ability to fight infection. In
light of these factors, it is sometimes difficult to determine the optimal
course for patient management.
This review is aimed at helping healthcare providers make better decisions about
treatment, resource use, and strategies for future foot ulcer prevention.
About the Authors
Reiber GE, Lipsky BA, Gibbons GW. (1998) The burden of diabetic foot ulcers. Am
J Surg. 1998 Aug;176(2A Suppl):5S-10S. Department of Epidemiology and Health
Services, University of Washington, VA Puget Sound Health Care System, Seattle
98108, USA.