Speciality
Spotlight

       




 


Medicine


   

 





Diabetes

     

  • Pittet
    D, Wyssa B, Herter-Clavel C, et al [Univ Hosp of
    Geneva, Switzerland]

    Outcome of Diabetic
    Foot Infections Treated Conservatively : A
    Retrospective Cohort Study with Long-term Follow-up

    Arch
    Intern Med 159: 851-856, 1999

      

    Diabetic
    foot lesions are the cause of more hospitalizations
    than any other complications of diabetes. Effective
    guidance needs to be enunciated to minimize human
    and financial cost of diabetic foot lesions. A
    5-year retrospective cohort study with prospective
    long-term follow up was undertaken to identify
    criteria predictive of failure of conservative
    treatment of such lesions.

     

    The
    Wagner classification system was used for this
    study. Variables examined included patient
    demographics, infection and diabetes.

      

    Of
    120 patients, 74% had contiguous osteomyelitis, deep
    tissue involvement or gangrene. 13% underwent
    immediate amputation. 
    Of the remaining, conservative treatment was
    successful in 63% of cases. 21 of 26 [81%] with skin
    ulcers. 35 of 50 [70%] with deep tissue infection or
    suspected osteomyelitis and 1 of 15 [7%] with
    gangrene.

      

    Independent
    factors predictive of failure were fever, elevated
    creatinine, prior hospitalization for diabetic foot
    lesion, duration of diabetes.

      

    Conservative
    measures including prolonged culture guided
    parenteral or oral antibiotics was successful
    without amputation in 63% of diabetic foot lesion.

         

  • Steven G Gabbe, Emily Holing, et al (Seattle, Washington)

    Benefits, risks, costs, and patient satisfaction associated with insulin pump therapy for the pregnancy complicated by type 1 diabetes mellitus.

    Am J Obstet Gynecol, 182; 1283-91

         

    Objective : Glycemic control, perinatal outcome, and health care costs were evaluated among women with type 1 diabetes mellitus who began insulin pump therapy during pregnancy (group 1, n =24), were treated with multiple insulin injections 

    (group2, n=24), or were already using an insulin pump before pregnancy (group 3, n=12). Patient satisfaction and continuation of pump therapy post partum were assessed.

     


    Study Design: A retrospective review of maternal and neonatal medical records was performed, and a questionnaire was sent to patients after delivery. Patients in groups 1 and 2 were matched for age, age at onset and duration of diabetes mellitus, white class and date of delivery.

     


    Results : After delivery 94.7% of the women in group 1 continued to use the pump because it provided better glycemic control and a more flexible lifestyle.

     


    Conclusions: Insulin pump therapy was initiated during pregnancy without a deterioration of glycemic control and was associated with maternal and perinatal outcomes and health care costs comparable to those among women who were already using the pump before pregnancy or who received multiple-dose insulin therapy. Women who began pump therapy in pregnancy were highly likely to continue pump use after delivery and preferred the flexible lifestyle that this treatment allowed.

     


    Insulin pump therapy was developed by Dr. Arnold Kadish of Los Angeles. The insulin pump from its onset was ocassionally used for pregnant women, especially for those women who had particularly brittle diabetes. Insulin lispro decreases the frequency of hypoglycemia and hemoglobin A1c with respect to other forms of insulin.

     


    The fetal malformation rate was 12.5% in both groups 1 and 2, reflecting the early fetal development during a time of hyperglycemia. In contrast, women who began pregnancy while already using the insulin pump and continued pump use did not have any fetal malformations in this study. Is this not enough evidence for us to encourage the use of the pump by all women of reproductive age who may be candidates?

      


    American Diabetes Association recommends that patients with diabetes maintain a hemoglobin A1c concentration of 7% or a mean glucose concentration of about150mg dL, just what our patients who continued to use the pump after delivery were able to do.

      


    Most of their patients take 3 or 4 injections per day, generally with neutral protamine Hagedorn insulin and regular insulin or insulin lispro.

      


    Finally, Dr. Bradley asked when pump therapy should be started. It think that ideally you would like it to begin before pregnancy, so that you can avoid the risks during pregnancy, particularly of ketoacidosis should you have pump failure.

        

  • PG
    Tawalkar

    Editorial – The Diabetic Foot

    JAPI, Vol.49, May 2001, p. 509


         


    The diabetic foot is one of the commonest
    complications of diabetes. The major factors
    involved in the causation are ischemia, neuropathy
    and infection. Delayed wound healing, dyslipidemias
    and tobacco worsen the problems in addition to
    impaired sensation. The dry fissured skin is the
    portal of entry for microorganisms and can lead to
    osteomyelitis. Very vigorous antibiotic treatment is
    required for diabetic foot infections, and surgical
    incision and drainage are important. Needless to say
    that control of blood glucose is important but
    surgical procedures should start even before
    complete blood sugar contro

         

  • Ian W Campbell, Victoria Hospitla, Kirkcaldy, Fife, Scotland 

    Antidiabetic Drugs Present and Future

    Will Improving Insulin Resistance Benefit Cardiovascular Risk in Type 2 Diabetes Mellitus?

    Drugs Nov.2000, 60(5), 1017-1028

       


    This survey in Scotland has revealed that treatment with sulfonylureas and insulin reduced only microvascular complication of diabetes but not the macrovascular complications. The only drugs, which possibly may be of benefit in reducing macrovascular complications are metformin and the glitazone group of insulin sensitizers. In addition, the statins would be of great use in the treatment of dyslipidaemia. Metformin particularly reduces glycosylated haemoglobin levels and reduces diabetes related risk and death by more than 36%. Metformin also reduces triglycerides and LDL cholesterol and slightly increases HDL. Pioglitazone also increases HDL cholesterol.

      

 



 

           

Speciality Spotlight

       

 
Medicine
   

 

Diabetes
     

  • Pittet D, Wyssa B, Herter-Clavel C, et al [Univ Hosp of Geneva, Switzerland]
    Outcome of Diabetic Foot Infections Treated Conservatively : A Retrospective Cohort Study with Long-term Follow-up
    Arch Intern Med 159: 851-856, 1999
      
    Diabetic foot lesions are the cause of more hospitalizations than any other complications of diabetes. Effective guidance needs to be enunciated to minimize human and financial cost of diabetic foot lesions. A 5-year retrospective cohort study with prospective long-term follow up was undertaken to identify criteria predictive of failure of conservative treatment of such lesions.
     
    The Wagner classification system was used for this study. Variables examined included patient demographics, infection and diabetes.
      
    Of 120 patients, 74% had contiguous osteomyelitis, deep tissue involvement or gangrene. 13% underwent immediate amputation.  Of the remaining, conservative treatment was successful in 63% of cases. 21 of 26 [81%] with skin ulcers. 35 of 50 [70%] with deep tissue infection or suspected osteomyelitis and 1 of 15 [7%] with gangrene.
      
    Independent factors predictive of failure were fever, elevated creatinine, prior hospitalization for diabetic foot lesion, duration of diabetes.
      
    Conservative measures including prolonged culture guided parenteral or oral antibiotics was successful without amputation in 63% of diabetic foot lesion.
         

  • Steven G Gabbe, Emily Holing, et al (Seattle, Washington)
    Benefits, risks, costs, and patient satisfaction associated with insulin pump therapy for the pregnancy complicated by type 1 diabetes mellitus.
    Am J Obstet Gynecol, 182; 1283-91
         
    Objective : Glycemic control, perinatal outcome, and health care costs were evaluated among women with type 1 diabetes mellitus who began insulin pump therapy during pregnancy (group 1, n =24), were treated with multiple insulin injections 
    (group2, n=24), or were already using an insulin pump before pregnancy (group 3, n=12). Patient satisfaction and continuation of pump therapy post partum were assessed.
     
    Study Design: A retrospective review of maternal and neonatal medical records was performed, and a questionnaire was sent to patients after delivery. Patients in groups 1 and 2 were matched for age, age at onset and duration of diabetes mellitus, white class and date of delivery.
     
    Results : After delivery 94.7% of the women in group 1 continued to use the pump because it provided better glycemic control and a more flexible lifestyle.
     
    Conclusions: Insulin pump therapy was initiated during pregnancy without a deterioration of glycemic control and was associated with maternal and perinatal outcomes and health care costs comparable to those among women who were already using the pump before pregnancy or who received multiple-dose insulin therapy. Women who began pump therapy in pregnancy were highly likely to continue pump use after delivery and preferred the flexible lifestyle that this treatment allowed.
     
    Insulin pump therapy was developed by Dr. Arnold Kadish of Los Angeles. The insulin pump from its onset was ocassionally used for pregnant women, especially for those women who had particularly brittle diabetes. Insulin lispro decreases the frequency of hypoglycemia and hemoglobin A1c with respect to other forms of insulin.
     
    The fetal malformation rate was 12.5% in both groups 1 and 2, reflecting the early fetal development during a time of hyperglycemia. In contrast, women who began pregnancy while already using the insulin pump and continued pump use did not have any fetal malformations in this study. Is this not enough evidence for us to encourage the use of the pump by all women of reproductive age who may be candidates?
      
    American Diabetes Association recommends that patients with diabetes maintain a hemoglobin A1c concentration of 7% or a mean glucose concentration of about150mg dL, just what our patients who continued to use the pump after delivery were able to do.
      
    Most of their patients take 3 or 4 injections per day, generally with neutral protamine Hagedorn insulin and regular insulin or insulin lispro.
      
    Finally, Dr. Bradley asked when pump therapy should be started. It think that ideally you would like it to begin before pregnancy, so that you can avoid the risks during pregnancy, particularly of ketoacidosis should you have pump failure.
        

  • PG Tawalkar
    Editorial – The Diabetic Foot
    JAPI, Vol.49, May 2001, p. 509
         
    The diabetic foot is one of the commonest complications of diabetes. The major factors involved in the causation are ischemia, neuropathy and infection. Delayed wound healing, dyslipidemias and tobacco worsen the problems in addition to impaired sensation. The dry fissured skin is the portal of entry for microorganisms and can lead to osteomyelitis. Very vigorous antibiotic treatment is required for diabetic foot infections, and surgical incision and drainage are important. Needless to say that control of blood glucose is important but surgical procedures should start even before complete blood sugar contro
         

  • Ian W Campbell, Victoria Hospitla, Kirkcaldy, Fife, Scotland 
    Antidiabetic Drugs Present and Future
    Will Improving Insulin Resistance Benefit Cardiovascular Risk in Type 2 Diabetes Mellitus?
    Drugs Nov.2000, 60(5), 1017-1028
       
    This survey in Scotland has revealed that treatment with sulfonylureas and insulin reduced only microvascular complication of diabetes but not the macrovascular complications. The only drugs, which possibly may be of benefit in reducing macrovascular complications are metformin and the glitazone group of insulin sensitizers. In addition, the statins would be of great use in the treatment of dyslipidaemia. Metformin particularly reduces glycosylated haemoglobin levels and reduces diabetes related risk and death by more than 36%. Metformin also reduces triglycerides and LDL cholesterol and slightly increases HDL. Pioglitazone also increases HDL cholesterol.
      

 

 

By |2022-07-20T16:41:23+00:00July 20, 2022|Uncategorized|Comments Off on Diabetes

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