DIABETIC FOOT - A PUBLIC HEALTH PROBLEM
Abstract:
Diabetes mellitus is a major problem for individ, medicine and societies. Despite the
progression made for the prevention and the treatment of diabetic chronic complications, amputations of
lower-extremity is still a major health problem, with psychosocial implications and high costs. Diabetic
foot is the mirror of diabetic chronic complications and c1uster in a different proportions micro- and
macroangiopathy, sensory, motor and autonomie neuropathy, osteo-arthropathy and skin disorders.
Amputations in diabetie patients represent 50% of nontraumatic amputations. The number of major
amputations decreased but minor amputations are still frequent. 85% of amputations are preceded of
foot ulcers and 15% of diabetic patients develop ulcer during their lifetime. Screening to identify the
patients at risk, followed by specific education, good metabolic control and proper footwear play an
important role in' the prevention of foot ulcer and amputation. For patients with foot ulcer and/or
amputation, therapeutic footwear promotes heeling and walking (associated with other medical and
surgical measures). It seems that.among the serious and costly chronic complications of diabetes
mellitus, such as cardiacdisease, renal failure‚ and blindness, the complications of the foot are best
represented: 40-70%, of non-traumatic amputations of lower limbs are due to diabetes. Anually, 2% of
diabetic patients will develop foot ulceration, while 15% will develop ulceration during their entire life.
Amputation rate varies largely among countries and geographical regions. 15-19% of patients were
reported to have undergone amputation with the diagnosis of diabetes mellitus at the time of the surgical
intervention. Discussions regarding the complications of the diabetic foot are focussed on two major
issues: foot ulceration and lower limb amputation. Combined, these two entities represent the cause of
substantial medical effort, contributing at the same time to significant morbidity and mortality in
diabetes mellitus. The link between diabetic ulceration and amputation of the lower limbs is unsolluble,
taking into account the fact that ulcerations preceed 85% of the amputations. Other risk factors for
amputations include a very old diabetes mellitus, licemic imballance, peripheric neuropathy,
peripheral.vascular disease, history of ulceration, anterior amputation, retinopathy", and nefropathy.
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