Purpose: A group of patients who were hospitalized for diabetic foot ulcers was classified according to the University of Texas Staging System for Diabetic Foot Ulcers, and we attempted to evaluate whether this staging system could be a criterion for treatment success using vacuum-assisted closure (VAC) technique. Materials and Methods: A total of 32 patients were diagnosed with diabetic foot ulcers according to the University of Texas Staging System for Diabetic Foot Ulcers. Of these, 24 patients who were evaluated as stage B according to the staging system were classified as Group 1, and 8 patients in stage D were classified as Group 2. After applying VAC, the treatment success rate was compared by evaluating the size and severity of ulcers between the two groups. Results: The grade of granulation after VAC was on average 3.75±0.53 in Group 1 and 2.25±0.71 in Group 2. There was better granulation after VAC application in Group 1 (p<0.01). The success rate of the treatment was 22 cases (91.67%) in Group 1 and one case (12.5%) in Group 2. Thus there were statistically significant differences in the success rate of treatment between groups 1 and 2 (Pearson's chisquare test, p=0.01; odd ratio 77.00, 95% confidence interval [CI] 1.26~14.66; relative risk 4.30, 95% CI 1.26~14.66). Conclusion: These results suggest that there was a higher success rate of treatment with VAC in stage B patients. The University of Texas Staging System for Diabetic Foot Ulcers can thus be an index for applying VAC to patients with infective diabetic foot ulcers.
The increased oxidative stress may play an important role on the pathogenesis of diabetes and diabetic complications, and the blood level of vitamin C and lipid peroxidation in NIDDM patients may be used as an indicator for oxidative stress. However there is only scanty evidence on the blood level of vitamin C in NIDDM patients with or without diabetic complications. The study population consisted of 90 NIDDM patients(diabetes without complication, 48, and diabetes with complications, 42) and 41 normal subjects. The 42 diabetic complications were divided into 3 groups : 15 diabetic nephropathy, 18 diabetic neuropathy, 9 diabetic retinopathy. The anthropometric data and blood biochemical data were studied. The dietary intake was determined by 24 hour recall methods and food frequency questionnaire. The plasma concentrations of MDA and vitamin C were determined by fluorophotometer and HPLC respectively. 1) In blood lipoprotein study, diabetes with complication had higher level of TG than diabetes without complications, while no significant differences in total cholesterol, HDL, and LDL were shown. Diabetic neuropathy had the highest TG level among diabetic complication groups. 2) The intakes of vitamin B complexes(vitamin B$_2$, vitamin B$_{6}$, not vitamin B$_1$) and antioxidant vitamins(vitamin A and vitamin E, not vitamin C) and certain minerals such as iron and calcium in diabetes were not sufficient but the intakes of energy, protein, niacin, and phosphorus in diabetes were sufficient. The dietary intakes between diabetes with-and without complications were not significantly different. Among diabetic complications, the diabetic retinopathy had the lowest intake of vitamin B$_2$ and B$_{6}$(p < 0.05). the diabetic neuropathy or nephropathy consumed extremely low amount of vitamin A. 3) The MDA concentrations of NIDDM was significantly higher than that in controls(p < 0. 05) while no significant difference in the MDA concentration between with and without complications was shown. Although there were no statistical differences, the diabetic nephropathy and diabetic neuropathy showed the higher concentration of MDA than the diabetes without complications or diabetic retinopathy. 4) The plasma concentration of vitamin C in controls was higher than that in diabetes(p < 0.05) while the plasma vitamin C in diabetes with and without complications were similar. In diabetic complications, no differences in plasma vitamin C concentration of three groups were shown. This study showed that the oxidative stress in NIDDM patients was highly increased and the vitamin C reserve was significantly depleted, as compared with normals, although their intakes of vitamin C met korean RDA, which means that diabetes need more vitamin C intake to decrease oxidative stress in NIDDM patients.nts.
The purposes of this article are to review the pathogenesis, prevention, and management of amputation due to diabetes mel1itus complications, and to report one case who had lost his toes due to diabetes mellitus. A primary cause for hospital admission of the patient was foot ulcer. Since many amputations in diabetic patients are precipitated by such ulcers, a program for active prevention and optimal treatment of diabetic foot lesions might decrease the risk of amputation. Diabetic foot ulcers and, ultimately, amputation can stem from a variety of pathways. The combination of peripheral neuropathy, peripheral vascular disease and infections is the harbinger of the final cataclysmic events of gangrene and amputation. As the physical therapist is often involved in the treatment of diabetic patients, the therapist should be aware of the followings: the patient's type of diabetes and the severity of the diabetes, the complications of the disease, the effects of exercise, the importance of wearing proper shoes and education to patients about appropriate diabetic foot care.
The goal of this study was to investigate abnotmalities in camitine metabolism present by determining blood camitine and lipid concentrations in Korean diabetic patients. The study subjects included 108 Korean diabetic patients (64 males and 44 females) who were hospitalized in Chonbuk National University Hospital and 27 subjects were also hospitalized as non-diabetic controls (10 males and 17 females). Glucose, total cholesterol, triglyceride (TG) and HDL-cholesterol in plasma were enzymatically assayed and insulin was measured by immunoradiometric assay. Nonesterified camitine (NEC), acid-soluble acylcarnitine (ASAC), and acid-insoluble acylcarnitine (AIAC) were determined by a modified radioisotopic method Glucose and insulin levels were significantly elevated in diabetic patients compared with controls. Total cholesterol was elevated in female but not male diabetic patients and triglycerides were elevated both in male and female diabetics. Plasma and urinary total carnitine (TCNE) were significantly elevated in diabetics as compared with normal controls. In male diabetics, NEC concentrations were significantly elevated above controls, but not in female subjects. Plasma NEC and TCNE concentrations were significantly increased in male diabetics, but significantly decreased in female diabetics. All urinary carnitine concentrations were significantly increased in diabetics as compared with controls. Urinary NEC concentrations were four times higher in male diabetics and three times higher in female diabetics than in controls. The ratios of serum and urinary acylcarnitine/NEC were also significantly higher in diabetics than in controls. This study suggested that there was a remarkable abnormality in lipid and carnitine metabolism in Korean diabetic patients, and the further study on carnitine metabolism and the effects of carnitine supplementation for Korean diabetic patients are needed.
The Republic of Korea (ROK) has been putting much effort to deal with diabetes which is being increasingly found in all age groups due to inadequate diet. Diabetes is closely related to one's eating habits and lifestyle that often cause hyperglycemia so that it is essential for the diabetic patients to change them to improve or control the major symptoms of diabetes. This study introduces a software engineering solution to support these patients. The software designed for the solution lets the patients to easily recognize their sugar levels and current treatment schemes and then advises a more effective approach along with the essential information through the embedded push service. The major goal of this study is to support diabetes patients by providing a convenient but effective means to prevent or improve diabetic symptoms by patients themselves who will in turn change their lifestyles in a positive manner.
Purpose: This study was done to investigate the degree of self-care, family support and depression, and relationship among these variables for elder with diabetes mellitus. Method: Participants were 202 diabetic patients, 65 years or over, living in Seoul, Korea. Data were collected using the self-care tool for diabetic patients by Kim (1996), the family support tool for diabetic patients by Park (1984), and Korea's BDI scale by Lee (1995). Results: Of the patients, 43.1% showed HbAlc levels than higher 7%. The highest mean score was for self-care for medication compliance, and the lowest for blood glucose testing compliance. Factors affecting self-care were employment, education, HbAlc level, diabetic self-care education and complications. Factors affecting family support were living with family, diabetic self-care education, hospitalization and complications. Factors affecting depression were gender, living with family and complications. All of these factors were significant. Patients experiencing depression were 16.8% of patients. There was a significant positive correlation between self-care and family support, and significant negative correlations between self-care and depression, and family support and depression. Conclusion: For more effective management of diabetes mellitus in elders, improvement in self-care compliance, and family support are needed.
This study was carried out to investigate the relationship between diabetic control and related factors of the practice of diet therapy which affects mostly diabetic patients’ dietary compliance. A questionnaire survey was conducted on 128 diabetic patients who had visited Internal medicine endocrinology clinic at University Medical Center of Daegu area. The questionnaires including clinical characteristics, meal regularity and food intake which shows dietary compliance, intrinsic barriers to the practice of diet therapy and knowledge of diet therapy were asked and analyzed. The factor which affects HbA1c was intrinsic barriers and HbA1c became higher as the level of intrinsic barriers was increasing. The education on diet therapy had no influence on the intrinsic barriers, but the level of knowledge on diet therapy was shown higher in the educated patients. The above results suggest that the practice of diet therapy should be leaded to develop behavioral aspects through resonable motivation on dietary compliance along with removing intrinsic barriers rather than simply providing information.
Before studying the effectiveness of amitriptyline in alleviating the pain of diabetic neuropathy, this study was designed to compare the severity and nature of depressive symtoms of diabetic patients with neuropathy with those of diabetic patients without neuropathy and patients with somatoform disorder whose complaints were mainly somatic pain, respectively. The authors administered Beck Depression Inventory(BDI) to the three groups of patients. The mean total scores of BDI were relatively low in all groups and not significantly different among the three groups. The mean scores of four subscales of BDI were also not significantly different among the three groups. These results might suggest that the pain of diabetic neuropathy did not influence on the severity and the nature of depressive symptoms of preexisting diabetes.
It is generally accepted that diet modification provides beneficial effects on the management of diabetes. In the present study, we evaluated the effects of diet modification on nutrient intake and quality of life in a large sample of diabetic patients. This study was conducted using data from the Korea National Health and Nutrition Examination Survey IV and V (2007-2010). A total of 2,484 of diabetic patients were included in the analysis. Then, we compared the overall quality of dietary intake between diabetic patients with diet modification and those without dietary modification. The result showed that subjects on diabetic diet (DDG) showed lower levels of total cholesterol, triglyceride, and AST before and after the adjustment for covariates (all p < 0.05). The results of nutrient assessment showed that DDG had lower intakes of total energy, fat, and carbohydrate (all p < 0.05), but higher intakes of energy from protein, vitamin B1, vitamin B2, niacin and vitamin C than NDG. (all p < 0.05). In addition, nutritional adequacy ratio of calcium and vitamin B2 were significantly higher in DDG than those in normal diet group (NDG) (p < 0.05). However, we observed no significant differences in quality of life between two groups. In conclusion, diet modification in diabetic patients seemed to be effective to improve blood lipid profile and the adequacy of nutrient intake without sacrificing the quality of life.
Purpose: The purpose of this study was to evaluate the surgical outcome of split-thickness skin graft (STSG) for chronic diabetic wounds of the foot and ankle. Materials and Methods: The medical records of 20 patients who underwent surgery for chronic diabetic wounds of the foot and ankle between October 2013 and May 2018 were reviewed. Surgical management consisted of consecutive debridement, followed by negative-pressure wound therapy and STSG. We used an acellular dermal matrix between the wound and the overlying STSG in some patients with wide or uneven wounds. Patient satisfaction, comorbidities, wound size and location, length of hospital stay, wound healing time, and complications were investigated. Results: Of 20 patients, 17 (85.0%) were satisfied with the surgical outcome. Eight patients had diabetic wounds associated with peripheral vascular disease (PVD), 7 patients had diabetic wounds without PVD, and 5 patients had acute infection superimposed with necrotizing abscesses. The mean size of the wound was 49.6 cm2. The mean length of hospital stay was 33.3 days. The mean time to wound healing was 7.9 weeks. The mean follow-up period was 25.9 months. Complications included delayed wound healing (4 cases) and recurrence of the diabetic wounds (2 cases), which were resolved by meticulous wound dressing. Conclusion: STSG remains a good treatment strategy for chronic diabetic wounds of the foot and ankle.
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