Need for improved detection and management of those with diabetes and foot ulcers.
People with diabetes who develop foot ulcers are at more risk of dying prematurely than those without the complication, finds a new large-scale study.
Diabetes can damage a person's blood vessels and nerves, especially if their blood sugar is poorly controlled. Poor circulation and nerve damage in the feet makes people vulnerable to unnoticed cuts or other injuries and progress into poorly healing ulcers, or sores. In severe cases, this can lead to foot or leg amputation.
In a study of 17,830 patients with diabetes -- 3,095 diagnosed with foot ulceration and 14,735 without -- researchers from St George's, University of London investigated how diabetic foot ulcers affected a person's risk of dying earlier. They found that those with a history of foot ulceration had a higher death rate than those without. There were an extra 58 deaths per 1,000 people each year with diabetic foot ulcers.
People with foot ulcers and diabetes showed more cardiovascular risk factors, such as high blood pressure, and were more likely to die from cardiovascular causes. Approximately half of the additional mortalities were due to cardiovascular disease, such as heart attack or stroke.
The cause of non-cardiovascular deaths was not studied as part of this investigation but the researchers say this is potentially linked to infections and complications of foot ulceration, such as blood poisoning.
Robert Hinchliffe from St George's, University of London, who co-led the study, said: "Our research, which is the largest and therefore most reliable study to date, shows that people with diabetes who have foot ulcers are at considerably higher risk of an earlier death compared to those patients without. We suspect that this may be due in part to the effect of infections among those with foot ulcers and the greater co-existence of cardiovascular disease and foot ulcers with diabetes although the reasons are not entirely clear."
The researchers say these results underline the importance of a two-pronged approach for people with diabetes:
- Enhanced foot ulceration screening as early detection and treatment may help reduce some of the complications; and
- More intensive control of blood pressure and cholesterol among those diagnosed with foot ulcers as they are at higher cardiovascular risk.
Currently, experts already recommend that people with diabetes undertake a number of precautions to prevent foot ulcers including blood sugar control, wearing socks to prevent cuts, self-checking for abrasions and getting a complete foot examination at least once a year.
Existing guidelines to prevent cardiovascular disease include healthy diet choices, regular exercise, a medical check-up at least once a year and, often, medically prescribed drug treatment.
The above story is based on the October 10, 2012 news release by the University of St George's London.
The finding has been published in Diabetologia, the journal of the European Association for the Study of Diabetes:
J. R. W. Brownrigg, J. Davey, P. J. Holt, W. A. Davis, M. M. Thompson, K. K. Ray, R. J. Hinchliffe. The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis. Diabetologia, 2012; 55 (11): 2906 DOI: 10.1007/s00125-012-2673-3
Caring for Your Feet
There are many things you can do to keep your feet healthy.
Take care of your diabetes. Work with your health care team to keep your blood glucose in your target range.
Check your feet every day. Look at your bare feet for red spots, cuts, swelling, and blisters. If you cannot see the bottoms of your feet, use a mirror or ask someone for help.
Be more active. Plan your physical activity program with your health team.
Ask your doctor about special shoes.
Wash your feet every day. Dry them carefully, especially between the toes.
Keep your skin soft and smooth. Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between your toes. Read more about skin care.
If you can see and reach your toenails, trim them when needed. Trim your toenails straight across and file the edges with an emery board or nail file.
Wear shoes and socks at all times. Never walk barefoot. Wear comfortable shoes that fit well and protect your feet. Check inside your shoes before wearing them. Make sure the lining is smooth and there are no objects inside.
Protect your feet from hot and cold. Wear shoes at the beach or on hot pavement. Don't put your feet into hot water. Test water before putting your feet in it just as you would before bathing a baby. Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it.
Keep the blood flowing to your feet. Put your feet up when sitting. Wiggle your toes and move your ankles up and down for 5 minutes, two (2) or three (3) times a day. Don't cross your legs for long periods of time. Don't smoke.
Get started now. Begin taking good care of your feet today. Set a time every day to check your feet.
Get more details from the American Diabetes Association HERE.
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