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DOI: 10.12687/phleb2368-4-2017
Diabetic foot syndrome in elderly patients
Artikel in mehreren Sprachen: English | deutschPublikationsverlauf
Received:
03. April 2017
Accepted:
04. April 2017
Publikationsdatum:
05. Januar 2018 (online)
Summary
In elderly patients with diabetes mellitus and mild deterioration of the lower extremities, peripheral artery disease and diabetic peripheral neuropathy may contribute to the development of a diabetic foot syndrome. Early diagnosis and intervention can help to preserve the foot and thus significantly increase quality of life with diagnostic and therapeutic procedures being the same in elderly and in young patients.
Non-invasive diagnosis is possible in most bed-ridden patients and should take into account reasonable therapeutic options against the background of overall morbidity, physical performance and quality of life, which should be discussed with the patient and his relatives. Multidisciplinary care structures facilitate treatment and might lead to reduced amputation rates and an improved well-being.
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References
- 1 Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27: 1047-1053.
- 2 Rathmann W, Strassburger K, Heier M, Holle R, Thorand B, Giani G, Meisinger C. Original Article: Epidemiology Incidence of type 2 diabetes in the elderly German population and the effect of clinical and lifestyle risk factors: KORA S4 艠 F4 cohort study. Diabet Med 2009; 26: 212-1219.
- 3 Zeyfang A, Bahrmann A, Wernecke J. Praxisempfehlung Diabetes mellitus im Alter. Diabetologie 2016; 11 (Suppl. 02) S170-S176.
- 4 Diehm C, Schuster A, Allenberg JR, Darius H, Haberl R, Lange SF, Pittrow SD, von Stritzky B, Tepohl G, Trampisch HJ. High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis 2004; 172: 95-105.
- 5 Diehm C Allenberg JR, Pittrow D, Mahn M, Tepohl G, Haberl RL, Darius H, Burghaus I, Trampisch HJ. Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease. Circulation 2009; 120: 2053-2061.
- 6 Darius H, Trampisch HJ, Pittrow D, Allenberg JR, Haberl RL, Mahn M, Tepohl HG, Burghaus I, Diehm C. Comparison of two coronary risk equivalents: diabetes mellitus and peripheral arterial disease. Dtsch Med Wochenschr 2008; 133: 2317-2322.
- 7 Criqui MH, Langer RD, Fronek A, Feigelson HS, McCann TJ, Browner D. Mortality over a period of 10 years in patients with peripheral arterial disease. New England J Med 1992; 326: 381-386.
- 8 Krause D, Burghaus I, Thiem U, Ulrike U, Trampisch S, Trampisch M, Klaassen-Mielke R, Trampisch HJ, Diehm C, Rudolf H. The risk of peripheral artery disease in older adults – seven-year results of the getABi study. Vasa 2016; 45: 403-410.
- 9 Tesfaye S, Stevens LK, Stephenson JM, Fuller JH, Plater M, Ionescu-Tirgoviste C, Nuber A, Pozza G, Ward JD. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia 1996; 39: 1377-1384.
- 10 Wagner FW. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle 1981; 2: 64-122.
- 11 Armstrong DG. The University of Texas diabetic foot classification system. Ostomy Wound Manage 1996; 42: 60-61.
- 12 S3-Leitlinie zur Diagnostik, Therapie und Nachsorge der peripheren arteriellen Verschlusskrankheit. http://www.awmf-online.de.
- 13 Arsenault KA, McDonald J, Devereaux PJ, Thor-lund K, Tittley JG, Whitlock RP. The use of trans-cutaneous oximetry to predict complications of chronic wound healing: a systematic review and meta-analysis. Wound Repair Regen 2011; 19: 657-663.
- 14 OI Siitonen Niskanen LK, Laakso M, Siitonen JT, Pyorala K. Lower-extremity amputations in diabetic and nondiabetic patients. A population-based study in eastern Finland. Diabetes Care 1993; 16: 16-20.
- 15 Nationale Versorgungsleitlinie Neuropathie bei Diabetes im Erwachsenenalter. http://www.dmneuropathie.versorgungsleitlinien.de.
- 16 http://www.ag-fuss-ddg.de.
- 17 The Action to Control Cardiovascular Risk in Diabetes Study Group.. Effects of intensive glucose lowering in type 2 Diabetes. N Engl J Med 2008; 358: 2545-2559.
- 18 ADVANCE Collaborative Group.. Intensive glucose control and vascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med 2008; 358: 2560-2572.
- 19 Duckworth W, Abraira C, Moritz T. et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009; 360: 129-139.
- 20 Nordin C. The case for hypoglycaemia as a proar-rhythmic event: basic and clinical evidence. Diabetol Rev 2010; 53: 1552-1561.
- 21 Cox AJ, Azeem A, Yeboah J, Soliman EZ. et al. Heart Rate–Corrected QT interval is an independent predictor of All-Cause and Cardiovascular Mortality in individuals with type 2 Diabetes: The Diabetes Heart Study. Diabetes Care DOI: 10.2337/dc13–1257.
- 22 Fagher K, Nilsson A, Löndahl M. Heart rate- corrected QT interval prolongation as a prognostic marker for 3-year survival in people with type 2 diabetes undergoing above-ankle amputation. Diabet Med 2014; 32: 679-685.
- 23 Nationale Versorgungsleitlinie Therapie des Typ-2-Diabetes. http://www.diabetes.versorgungs/leitlinien.de.
- 24 Leitlinien für das Management der arteriellen Hypertonie. http://www.hochdruckliga.de.
- 25 Busch CH, Aschermann I, Mnich CHD. Treatment of chronic ulcers. A critical short analysis. Phlebologie 2017; 46: 13-18.
- 26 Deutsche Gesellschaft für Wundheilung und Wundbehandlung e.V. Lokaltherapie chronischer Wunden bei Patienten mit den Risiken periphere arterielle Verschlusskrankheit, Diabetes mellitus, chronische venöse Insuffizienz. http://www.awmfonline.de.
- 27 Nationale Versorgungsleitlinie Typ-2-Diabetes Präventions- und Behandlungsstrategien für Fuß-komplikationen. http://www.versorgungsleitlinien.de.
- 28 Evidenzbasierte Diabetes-Leitlinie DDG – Diabetisches Fußsyndrom, Update 2008 Diagnostik, Therapie, Verlaufskontrolle und Prävention des diabetischen Fußsyndroms. http://www.deutsche-diabetes-gesellschaft.de.
- 29 Lipsky BA, Aragón-Sánchez J, Diggle M, Embil J, Kono S. et al. on behalf of the International Working Group on the Diabetic Foot (IWGDF). IWGDF Guidance on the diagnosis and management of foot infections in persons with diabetes. http://www.iwgdf.org.
- 30 David JM, Gupta J, Hoffstad O, Padopoulos M, Glick HA, Thom R, Mitra N. Lack of Effectiveness of Hyperbaric Oxygen Therapy for the Treatment of Diabetic Foot Ulcer and the Prevention of Amputation. Diabetes Care 2013; 36: 1961-1966.
- 31 Elgzyri T, Larsson J, Nyberg P. et al. Early reascularization after admittance to a diabetic foot center affects the healing probability of ischemic foot ulcer in patients with diabetes. Eur J Vasc Endovasc Surg 2014; 48 (Suppl. 04) 440-446.
- 32 Schmidt A, Ulrich M, Winckler B, Klaeffing C. et al. Angiographic patency and clinical outcome after balloon-angioplasty for extensive infrapopliteal arterial disease. Catheter Cardiovasc Interv 2010; 76: 1047-1054.
- 33 Mustapha JA, Finton SM, Diaz-Sandoval LJ, Saab FA, Miller LE. Percutaneous Transluminal Angioplasty in Patients With Infrapopliteal Arterial Disease. Circulation: Cardiovascular Interventions 2016; 9: e003468 https://doi.org/10.1161/CIRCINTERVENTIONS.115.003468.
- 34 Bauer H, Germann G, Fa G. et al. Nationale Versorgungsleitlinie Typ-2-Diabetes-Prävention und Therapie von Fußkomplikationen. Berlin-Düsseldorf: BÄK, AWMF, KBV; 2016. http://www.versorgungsleitlinien.de.
- 36 Santosa F, Moysidis T, Kanya S, Babadagi-Hardt Z, Luther B, Kröger K. Decrease in major amputations in Germany. Int Wound. 2013 doi:10.1111/iwj.1209637.
- 37 May M, Hahn S, Tonn C, Engels G, Hochlenert D. Decrease in (Major) Amputations in Diabetics: A Secondary Data Analysis by AOK Rheinland/Hamburg. Journal of Diabetes Research. 2016 http://dx.doi.org/10.1155/2016/6247045.