The Role of New Technological Opportunities and the Need to Evaluate the Activities Performed in the Prevention of Diabetic Foot with Exercise Therapy

Piergiorgio Francia,Rosy Sinopoli,Roberto Anichini,Giulia Iannone,Alessandra De Bellis,Leonardo Bocchi

doi:10.3390/medicines8120076

Piergiorgio Francia, Rosy Sinopoli + Show 4 more

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https://doi.org/10.3390/medicines8120076

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Abstract

The diabetic foot (DF) is one of the most feared conditions among chronic complications of diabetes, which affects a growing number of patients. Although exercise therapy (ET) has always been considered a pillar in the treatment of patients at risk of DF it is not usually used. Several causes can contribute to hindering both the organization of ET protocols for Diabetes Units and the participation in ET programs for patients at different levels of risk of foot ulceration. The risk of favoring the occurrence of ulcers and the absence of clear evidence on the role played by ET in the prevention of ulcers could be considered among the most important causes leading to the low application of ET. The increased availability of new technologies and in particular of systems and devices equipped with sensors can enable the remote monitoring and management of physical activity performed by patients. Consequently, they can become an opportunity for introducing the systematic use of ET for the treatment of patients at risk. Considering the complexity of the clinical conditions that patients at risk or with diabetic foot ulcer can show, the evaluation of how patients perform the ET proposed can consequently be very important. All this can contribute to improving the treatment of patients and avoiding possible adverse effects. The aim of this brief review was to describe that the use of new technologies and the assessment of the execution of the ET proposed allows an important step forward in the management of patients at risk.

Highlights

Diabetic foot (DF) is a long-term diabetes complication that can increase morbidity and mortality in addition to affecting mobility and the overall well-being of patients
The risk of the occurrence of a foot ulcer, the lack of definitive evidences on the real role of exercise therapy (ET) in the prevention of DF as well as the difficulty of organizing and participating in ET programs are among the most important limitations that have hindered the relationship between physical activity (PA) management and DF prevention strategy
The availability of increasingly advanced technological solutions can allow the systematic use of ET in the prevention of DF and in the treatment of patients with active ulcers

Summary

Introduction

Diabetic foot (DF) is a long-term diabetes complication that can increase morbidity and mortality in addition to affecting mobility and the overall well-being of patients. The DF has a complex multifactorial pathogenesis that makes it difficult to prevent and treat [1]. In this sense, it is well known that the prevention and treatment of DF disease requires a multidisciplinary approach. In two thirds of cases there is a re-ulceration in the following three years even in the case of healing and it has been reported that up to 85% of diabetes amputations are preceded by a foot ulcer [3,4,5,6]. Due to the presence of multiple complications, the five-year mortality rate among patients with diabetes who have undergone major amputation procedures was reported to be higher than 40% [7,8,9]. Ulcers often result from a person with diabetes having concurrent or multiple risk factors where diabetic peripheral neuropathy

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