The Silent Threat: How Diabetic Foot Ulcers and the Fear of Amputation Shape Patients' Lives: A Qualitative Exploration of Patient Experiences.

Introduction: Diabetes is one of the most prevalent metabolic chronic diseases due to the imbalance production of insulin. One of the studies reported that in 2010 worldwide 285 million adults had diabetes and this figure may be increase to 439 million by the year 2030. Globally Diabetic foot ulcers (DFUs) constitute major health problem in people that significantly contribute to morbidity and mortality in diabetes patients. Approximate 1.0% to 4.1% of the annual population-based incidences of a diabetic foot ulcer (DFU) were reported. Due to this the lifetime may be as high as 25%. In Asian countries diabetic foot ulcer are major problems which are different from European countries or developing countries. From many studies reported diabetic foot problems in India are infectious and neuropathic in nature as compared to developed countries. According to World Health Organization (WHO) diabetic foot is defined as lower limb of a diabetic patient characterized by infection, potential risk of pathologic consequences ulceration or destruction of deep tissues associated with neurological abnormalities, various changes in peripheral neuropathy vasculopathy and superimposed infection that are mainly responsible foot ulceration. Ulcers are one kind of abscess which is difficult to treat because of poor wound healing that result from a combination of neuropathy, ischemia and hyperglycemia. 
 Aim: The main objective was to study the outcome of treatment modalities and it’s relating factors to complication in diabetic foot ulcer. Material and method: Total 60 diabetic foot ulcer patients with the age range from 20 to 70 years were included. From all the patients’ detailed past and present history were recorded. For all the patients, general, physical and local and systemic examinations were also done. Detail laboratory examination like Fasting and Post Prandial Blood sugar levels, blood count, ECG, ESR, complete urine examination for the presence of ketone bodies and sugar, x-ray as well as culture and sensitivity of the discharge from ulcer were also done. Patients were treated with various treatment methods like conservative treatment, split skin grafting and amputation.
 Result: In this study male patients were more in proportion as compared to female. This study showed that maximum with the age group 14 -50 (43.3%) years old followed by 18.3% in 31-40 years old, 16.7% in 61-70 years old. 6.7% showed the least age group as 20 -30 years old. Out of total 60 patients, 38.3% of the patients showed diabetic ulcer foot which was more whereas 15% showed diabetic gangrene foot which was least. 25% showed diabetic cellulites foot and 21.7% showed as diabetic abscess foot. 
 Conclusion: Globally as diabetes mellitus cases are increasing and it became rapidly the public health problem. This may be due to burden on economy, health system and on society to manage the diabetic foot problems. Diabetic foot management guidelines must be made into our practice protocols which may preventing limb loss, and decrease mortality and increase the quality of life of the patient. Hence for this it is only possible with the help of foot care education and health care workers. Hence, foot infection is to put first and care for it like hands.
 Keywords: Diabetes, foot ulcers, infections, amputations.

<p>The number of Diabetic Foot Ulcer (DFU) cases is growing due to the rising number of older persons in society and the increasing worldwide prevalence of diabetes mellitus (DM). Indeed, a DFU occurs in approximately 1 out of every 7 patients with DM. Clinical preventive and management interventions for DFU typically include the employment of multiple guideline-based interventions, with the goal of preventing the onset of DFU in the first place. The development of new and effective interventions in wound care generally remains an area of intense research interest, especially in DFU, where the search continues for evidence on high efficacy, yet cost effective interventions. This clinically focussed paper will present an overview of DFU, introduce some of the costs associated with DFU prevention and management in addition to including important treatment considerations. This paper also highlights the urgent need for more high quality robust clinical trial research to meet the expanding treatment needs of this growing patient population</p>

Diabetic foot complications are a major challenge for the healthcare system, with enormous economic consequences for the patients, their families, and the society and a leading cause of mortality and morbidity in developing countries. Diabetic foot ulcer (DFU) is the most costly and devastating complication, which affects 15% of diabetic patients during their lifetime. Good knowledge, attitude, and practice regarding diabetic foot care will reduce the risk of diabetic foot complications and ultimately amputations. The aim of this study was to assess the knowledge, attitude, and practice of foot care among type 2 diabetic patients and to determine the relationship between proper foot care and diabetic foot lesions. This is an observational, descriptive, cross-sectional, hospital- based study. It was conducted in the diabetic out-patient clinic at Al-Ribat University Hospital, in Khartoum, Sudan 2016. A total number of 156 type 2 diabetic patients were enrolled in this study; with 75% of the participants were females and 25% males. Duration of DM, exercise, smoking adherent to diabetic diet, type of therapy, co-morbidity, foot lesions, and foot care knowledge, attitude, and practice were tested. Having diabetes longer than 10 years were 37.8%, mean age was 53.4 ± 7.68 years. There was high prevalence of peripheral neuropathy(PN) symptoms 56.4% while 42.3% of the patients had peripheral arterial disease symptoms .17 patients had loss of sensation while only 2 patients had loss of peripheral pulses (dorsalis pedis and posterior artery pulses). Regarding knowledge, attitude, and practice about diabetic foot care, 56.5% had good foot care knowledge, 70.5% had bad attitude, and 62.2% had moderate practice. Based on Chi square test of relationship between proper foot care and diabetic foot ulcer (DFU), there was association between bad knowledge, attitude, and practice about foot care and DFU, P. values: 0,03, 0,000, 0.036 respectively. Advising the diabetics about frequent foot care clinic visits, regular feet examination, proper footwear, exercise program, and smoking cessation would be beneficial in preventing diabetic foot complication. Policy and decision makers should initiate interventional foot care education programs throughout the country, with our ultimate goal is to save limbs.

Chronic wounds, including pressure sores, leg ulcers, diabetic foot ulcers and other kinds of wounds, healing by secondary intention are common in both acute and community settings. The prevention and treatment of chronic wounds includes many strategies, including the use of various wound dressings, bandages, antimicrobial agents, footwear, physical therapies and educational strategies. This review is one of a series of reviews, and focuses on the prevention and treatment of diabetic foot ulcers and the role of antimicrobial agents in chronic wounds in general. To assess the clinical- and cost-effectiveness of (1) prevention and treatment strategies for diabetic foot ulcers and (2) systemic and topical antimicrobial agents in the prevention and healing of chronic wounds. METHODS - DATA SOURCES: Nineteen electronic databases were searched, including MEDLINE, CINAHL, Embase and the Cochrane Library. Relevant journals, conference proceedings and bibliographies of retrieved papers were hand-searched. An expert panel was consulted. Randomised and non-randomised trials with a concurrent control group, which evaluated any intervention for the prevention or treatment of diabetic foot ulcers, or systemic or topical antimicrobials for chronic wounds (diabetic foot ulcers, pressure ulcers, leg ulcers of various aetiologies, pilonidal sinuses, non-healing surgical wounds, and cavity wounds) and used objective measures of outcome such as: (1) development or resolution of callus; (2) incidence of ulceration (for diabetic foot ulcer prevention studies); (3) incidence of pressure sores (pressure sore prevention studies); (4) any objective measure of wound healing (frequency of complete healing, change in wound size, time to healing, rate of healing); (5) ulcer recurrence rates; (6) side-effects; (7) amputation rates (diabetic foot ulcer treatment studies); (8) healing rates and recurrence of disease, among others, for pilonidal sinuses. Studies reporting solely microbiological outcomes were excluded. Decisions on the inclusion of primary studies were made independently by two reviewers. Disagreements were resolved through discussion. Data were extracted by one reviewer into structured summary tables. Data extraction was checked independently by a second reviewer and discrepancies resolved by discussion. All included studies were assessed against a comprehensive checklist for methodological quality. INCLUDED STUDIES - DIABETIC FOOT ULCERS: Thirty-nine trials which evaluated various prevention and treatment modalities for diabetic foot ulcers: footwear (2), hosiery (1), education (5), screening and foot protection programme (1); podiatry (1) for the prevention of diabetic foot ulcers; and footwear (1), skin replacement (2), hyperbaric oxygen (2), ketanserin (3), prostaglandins (3), growth factors (5), dressings and topical applications (9), debridement (2) and antibiotics (2) for the treatment of diabetic foot ulcers. INCLUDED STUDIES - ANTIMICROBIALS: Thirty studies were included, 25 with a randomised design. There were nine evaluations of systemic antimicrobials and 21 of topical agents. The methodological and reporting quality was generally poor. Commonly encountered problems of reporting included lack of clarity about randomisation and outcome measurement procedures, and lack of baseline descriptive data. Common methodological weaknesses included: lack of blinded outcome assessment and lack of adjustment for baseline differences in important variables such as wound size; large loss to follow-up; and no intention-to-treat analysis. RESULTS - PREVENTION OF DIABETIC FOOT ULCERS: There is some evidence (1 large trial) that a screening and foot protection programme reduces the rate of major amputations. The evidence for special footwear (2 small trials) and educational programmes (5 trials) is equivocal. A single trial of podiatric care reported a significantly greater reduction in callus in patients receiving podiatric care. RESULTS - TREATMENT OF DIABETIC FOOT ULCERS: Total contact casting healed significantly more ulcers than did standard treatment in one study. There is evidence from 5 trials of topical growth factors to suggest that these, particularly platelet-derived growth factor, may increase the healing rate of diabetic foot ulcers. Although these studies were of relatively good quality, the sample sizes were far too small to make any definitive conclusions, and growth factors should be compared with current standard treatments in large, multicentre studies. Topical ketanserin increased ulcer healing rate in 2 studies, while systemic hyperbaric oxygen therapy reduced the rate of major amputations in 1 study. Preliminary research into the effects of iloprost and prostaglandin E1 (PGE1) on diabetic foot ulcer healing suggests possible benefits. However, good quality, large-scale confirmatory research is needed. (ABSTRACT TRUNCATED)

Background: Many types of infection can cause diabetic foot ulcers Infections involving the bacteria; E. coli, Acinetobacter spp (MDR) and K. pneumoniae, pseudomonas aeruginosa, so the assessment of Bacterial profile and patterns is needed to understand the source and management of these injuries.
 Objective: To determine Bacterial infections profile and patterns for diabetic foot ulcers in nongovernmental.
 Method: During a period of eleven months, 148 patients with diabetic mellitus foot syndrome (DMFS). Patients were involved, out of 130 which foot ulceration infections. data analysis was done using SPSS version 20. p value was set at <0.05.
 Results: Out of 607 Patients with diabetic foot ulceration (DFU) were 130 out of 148 with diabetic mellitus foot syndrome (DMFS). Diabetic foot ulceration (DFU) therefore contributed 20.3% of DMFS among these subjects. Microbiological culture pattern was total of 17 different pathogenic microorganisms were isolated from the participants, one yeast and 16 types of bacteria, from the diabetic foot swabs for ulcers. S. aureus was the most frequent pathogen followed by E.coli then Acinetobacter spp (MDR) and K. pneumonia, then pseudomonas aeruginosa , then p. mirabilis then Streptococcus agalactiae ( group b) then (Enitrobacteria spp and pseudomonas spp and Candida spp and P. vulgaris and K. oxytoca ESBL) then S. viridanse and Enterobacter spp ESBL and Staphylococcus coag. negative). The Enterobacter spp ESBL was the less frequent pathogen.
 Conclusion: Diabetic Foot Ulcerations (DFU), is forming about a quarter of the diabetic patient’s tissue infections, the causative agents were bacterial and fungal(yeast). Most of the causative pathogens were; Staphylococcus aureus, and Acinetobacter spp (MDR). The risk of development of High resistant drug isolates of diabetic foot ulcers to be multidrug resistance were high by 53% of total isolated pathogens specially with K. pneumonia (K. pneumoniae), Escherichia coli (E. coli) and Proteus mirabilis bacterial.

Introduction: Diabetic foot ulcers (DFU) are a devastating complication of diabetes. There are numerous challenges with preventing diabetic foot complications and barriers to achieving the care processes suggested in established foot care guidelines. Multi-faceted digital health solutions, which combine multimodal sensing, patient-facing biofeedback, and remote patient monitoring (RPM), show promise in improving our ability to understand, prevent, and manage DFUs. Methods: Patients with a history of diabetic plantar foot ulcers were enrolled in a prospective cohort study and equipped with custom sensory insoles to track plantar pressure, plantar temperature, step count, and adherence data. Sensory insole data enabled patient-facing biofeedback to cue active plantar offloading in response to sustained high plantar pressures, and RPM assessments in response to data trends of concern in plantar pressure, plantar temperature, or sensory insole adherence. Three non-consecutive case participants that ultimately presented with pre-ulcerative lesions (a callus and/or erythematous area on the plantar surface of the foot) during the study were selected for this case series. Results: Across three illustrative patients, continuous plantar pressure monitoring demonstrated promise for empowering both the patient and provider with information for data-driven management of pressure offloading treatments. Conclusion: Multi-faceted digital health solutions can naturally enable and reinforce the integrative foot care guidelines. Multi-modal sensing across multiple physiologic domains supports the monitoring of foot health at various stages along the DFU pathogenesis pathway. Furthermore, digital health solutions equipped with remote patient monitoring unlock new opportunities for personalizing treatments, providing periodic self-care reinforcement, and encouraging patient engagement—key tools for improving patient adherence to their diabetic foot care plan.

Objectives: Patients with Diabetic Kidney Disease (DKD) and foot ulcer have poor prognosis. However, no study have found association of diabetic foot ulcer (DFU) with diabetic kidney dysfunction and their co-existing risk factors. Materials and Methods: This cross sectional study collected the data for 10,680 patients for 15 years. All variables were analyzed biochemically and statistically by standardized methodology. Results: Levels of HbA1c, creatinine, systolic and diastolic blood pressures, microalbuminuria, spot urine protein, and spot urine protein to creatinine ratio were higher among the groups with foot ulcers (p-value < 0.0001 for all). Average ABI was observed to be lower among the groups demonstrating nephropathy and DKD (p=0.025 and 0.022 respectively. DFU was significantly associated with HTN (odds ratio 2.2; 95% CI 1.66 to 2.9; p < 0.0001), nephropathy (odds ratio 4.77; 95% CI 3.53 to 6.5; p < 0.0001) and DKD (odds ratio 4.77 and 6.83; 95% CI 4.6 to 10.2; p < 0.0001). HbA1c of 7.8% was 60% sensitive and 52% specific for the development of DFU. Creatinine of 1.2 mg/dl was 75% sensitive and 48% specific for DFU. Spot urine protein excretion from nephrons of 35 mg/dl was 88% sensitive and 90% specific for the development of DFU. Conclusion: Nephropathy/DKD are risk factors for the development of DFU. With optimal diabetes control, regular and routine assessment of the feet and early screening of diabetic patients for neuropathy, nephropathy, hypertension, dyslipidaemia and other diabetic complications are essential. Doi: 10.28991/SciMedJ-2021-0304-6 Full Text: PDF

Diabetic foot ulcers (DFU) can be avoided if symptoms of diabetic foot complications are detected early and treated promptly. Early detection requires regular examination, which might be limited for many reasons. To identify affected or potentially affected regions in the diabetic plantar foot, the region-wise severity of the plantar foot must be known. A novel thermal diabetic foot dataset of 104 subjects was developed that is suitable for Indian healthcare conditions. The entire plantar foot thermogram is divided into three parts, i.e., forefoot, midfoot, and hindfoot. The division of plantar foot is based on the prevalence of foot ulcers and the load on the foot. To classify the severity levels, conventional machine learning (CML) techniques like logistic regression, decision tree, KNN, SVM, random forest, etc., and convolutional neural networks (CNN), such as EfficientNetB1, VGG-16, VGG-19, AlexNet, InceptionV3, etc., were applied and compared for robust outcomes. The study successfully developed a thermal diabetic foot dataset, allowing for effective classification of diabetic foot ulcer severity using the CML and CNN techniques. The comparison of different methods revealed variations in performance, with certain approaches outperforming others. The region-based severity analysis offers valuable insights for targeted interventions and preventive measures, contributing to a comprehensive assessment of diabetic foot ulcer severity. Further research and development in these techniques can enhance the detection and management of diabetic foot complications, ultimately improving patient outcomes.

Background Diabetic foot ulcers (DFUs) are a common and serious complication of diabetes, often leading to amputation and decreased quality of life. Current treatment methods have limited success rates, highlighting the need for new approaches. This study investigates the potential of tibial transverse transport (TTT) to promote wound healing in DFUs. Methods To test this hypothesis, the study used New Zealand White rabbits to establish a diabetic model and simulate foot ulcers, followed by the treatment of unilateral TTT or bilateral TTT. The study employed histological analysis, flow cytometry, ELISA, and qPCR to assess the impact of TTT on tissue repair and endothelial progenitor cell (EPC) mobilization and homing, aiming to understand the underlying biological processes in wound healing. Results TTT significantly enhanced wound healing in diabetic rabbit foot ulcers. Specifically, bilateral TTT led to complete wound healing by day 19, faster than the unilateral TTT group, which healed by day 26, and the sham operation group, which nearly healed by day 37. Histological analysis showed improved tissue architecture, collagen deposition, and neovascularization in TTT-treated groups. Furthermore, TTT treatment resulted in a significant increase in VEGFR2 expression and VEGFR2/Tie-2 positive cells, particularly in the bilateral group. These findings were corroborated by qPCR results, which showed increased expression of VEGFA and CXCL12 by TTT. Conclusions: TTT may be a promising treatment for DFUs, significantly enhancing wound healing by stimulating EPC mobilization and homing mediated angiogenesis. This novel approach could substantially improve treatment outcomes for diabetic patients with chronic foot ulcers.

Diabetic foot ulcer (DFU) is a serious complication of poorly controlled diabetes, commonly affecting the plantar surface of the foot. Nearly 15% of diabetic individuals develop DFU, and 14–24% may require amputation. It results from neuropathy, vascular insufficiency, and infection. Prevention through foot care education is essential to reduce complications. Diabetic foot ulcers are a major cause of morbidity and amputation among diabetic patients, especially in rural areas, due to poor awareness, delayed treatment, and inadequate self-care practices. This review is needed to evaluate existing evidence on foot care education, identify knowledge gaps, and guide effective interventions to improve self-care practices and prevent diabetic foot ulcers. To review and synthesize existing evidence on the effectiveness of foot care education in improving knowledge and self-care practices for the prevention of diabetic foot ulcers among diabetic patients, with special emphasis on rural populations. A comprehensive literature review was conducted using PubMed and Google Scholar. MeSH terms like 'diabetic foot' and 'self-care' and keywords such as 'practice' and 'behaviour' were used to identify relevant English-language studies. Findings showed varied assessment tools including Modified Diabetic Foot Care Knowledge (MDFCK), Modified Diabetic Foot Care Behaviours (MDFCB), Nottingham Assessment of Functional Foot Care (NAFFC), Diabetes Knowledge Test (DKT), and Diabetes Foot Care Questionnaire (DFQ). Most studies used questionnaires focusing on hygiene, foot inspection, footwear, and self-care practices. However, inconsistency in tool usage and validation was noted. Overall, patients demonstrated inadequate knowledge and poor self-care practices. The review highlights the need for effective educational interventions to improve foot care knowledge and practices, especially among high-risk groups such as rural populations and individuals with low literacy levels.

Diabetes mellitus (DM) is a chronic disease that can lead to serious complications, one of which is diabetic foot ulcer (DFU). Inadequate foot care increases the risk of ulcer development; therefore, its association needs to be examined scientifically. This study aimed to analyze the association between foot care and the incidence of diabetic foot ulcers in patients with diabetes mellitus. A correlational analytical design with a cross-sectional approach was employed. The sample consisted of 60 patients with diabetes mellitus selected using purposive sampling. Foot care data were collected using the Nottingham Assessment of Functional Footcare (NAFF) questionnaire, while the incidence of diabetic foot ulcers was assessed through an observation checklist. Data were analyzed using Spearman’s rho correlation test. The results demonstrated a statistically significant association between foot care and the incidence of diabetic foot ulcers (p = 0.008 < α = 0.05). Patients with poor foot care tended to experience diabetic foot ulcers with greater severity. In conclusion, appropriate foot care plays an important role in the prevention of diabetic foot ulcers. Therefore, health education and the establishment of routine foot care practices should be strengthened to reduce the risk of complications and improve the quality of life of patients with diabetes mellitus.

ABSTRAKDiabetic Foot Ulcer (DFU) termasuk kedalam salah satu komplikasi dari penyakit Diabetes Melitus yang mana kondisi ini merupakan masalah yang serius juga dapat menyebabkan kecacatan. Dampak merugikan pada ulkus kaki diabetik ialah biologis, psikologis, sosial ekonomi dan spiritual. Dampak psikologis yang sering terjadi pada pasien DFU ialah depresi. Depresi merupakan gangguan psikologis yang sering dikaitkan dengan stressor jangka panjang seperti penyakit kronis diantaranya diabetes melitus. Penelitian dilakukan berjutuan untuk mengetahui hubungan antara derajat DFU terhadap tingkat depresi pada pasien diabetes melitus di RSUD Dr.H.Moch Ansari Saleh Banjarmasin. Penelitian ini menggunakan metode kuantitatif dan menggunakan kuesioner sebagai alat pengupulan data. dengan jumlah 40 responden dengan Non-probability dengan teknik pengambilan sampel menggunakan Sampling Jenuh dengan semua menjadi sampel dengan jumlah 40 responden yang sedang menjalani rawat jalan dipoli kaki diabetik. Untuk alat ukur derajat dfu menggunakan kuesioner Diabetic Foot Ulcer Wegner dan kuesioner Back Depresion Inventory (BDII) untuk mengukur tingkat depresi. Hasil penelitian menjunjukan bahwa terdapat hubungan antara derajat diabetic foot ulcer terhadap tingkat depresi dengan hasil Sig. (2-tailed) (<0,05), yang artinya adanya hubungan yang signifikan antara derajat diabetic foot ulcer terhadap tingkat depresi pada pasien diabetes melitus. Kata kunci: Diabetic Foot Ulcer, Tingkat Depresi ABSTRACTDiabetic Foot Ulcer (DFU) is one of the complications of Diabetes Mellitus, where this condition is a serious problem and can also cause disability. The detrimental impacts on diabetic foot ulcers are biological, psychological, socio-economic and spiritual. The psychological impact that often occurs in DFU patients is depression. Depression is a psychological disorder that is often associated with long-term stressors such as chronic diseases including diabetes mellitus. Several studies were conducted to determine the relationship between the degree of DFU and the level of depression in diabetes mellitus patients at Dr.H.Moch Ansari Saleh Hospital, Banjarmasin. This research uses quantitative methods and uses questionnaires as a data collection tool. with a total of 40 respondents with Non-probability with a sampling technique using Saturated Sampling with all being sampled with a total of 40 respondents who were undergoing outpatient treatment at the diabetic foot clinic. To measure the degree of dfu, Wegner's Diabetic Foot Ulcer questionnaire and the Back Depression Inventory (BDII) questionnaire are used to measure the level of depression. The results of the study showed that there was a relationship between the degree of diabetic foot ulcers and the level of depression and the Sig results. (2-tailed) (<0.05), which means there is a significant relationship between the degree of diabetic foot ulcers and the level of depression in diabetes mellitus patients.Keywords: Diabetic Foot Ulcer, Depression Rate

Introduction: One of the complications of diabetes is diabetic foot ulcers which is very common in these patients. Given that in Studies, found that diabetic foot complications increase with age. Therefore, considering the importance of diabetic foot ulcer treatment in diabetic patients, this systematic review was conducted on Diabetic foot ulcer (DFU) and Its pharmaceutical and therapeutic strategies. Materials and Methods: In this systematic review, this integrated overview study was conducted based on the Broome method. The present study is a systematic review article that was conducted in English and Persian by searching articles in search engines, scholar, PubMed, Springer's reputable scientific sites and databases. Using the articles published in the last 20 years, it was based on the most important treatments for diabetic foot ulcers. In the first stage, 39 papers were found. Of these, 11 articles related to the topic that was published in the last 20 years were reviewed. Results: In this study, several methods for the treatment of diabetic foot ulcers have been investigated. In a study, in the treatment of chronic ulcers of grade 3 diabetes mellitus based on Wegener's classification, ultrasound waves of low frequency with standard care of the wound compared with standard care from scarring alone initially caused Accelerated recovery of chronic diabetic foot ulcers especially in the second and third months, while after 6 months of follow up, there was no significant difference in wound healing. Conclusion: In this study, as stated, our goal is to examine diabetic foot ulcer and their therapeutic and therapeutic strategies, that the results of various studies show that there are several therapeutic and therapeutic methods for treating diabetic foot ulcers. It is recommended that with screening and blood glucose control, prevent ulcers that cause amputation of the foot.

Purpose: Diabetes affects more than 170 million people over the age of 20 worldwide. Diabetic foot ulcers (DFU) are one of the most common complications of diabetes. It negatively influence the patients' quality of life. Multidisciplinary treatment is required in the treatment of DFUs. In our study, we aimed to investigate the effectiveness of intralesional epidermal growth factor (EGF) in diabetic neuropathy foot ulcers.
 Materials and Methods: The study was conducted with 29 patients who applied to our clinic due to diabetic foot wounds between January 2014 and December 2020, who had no wound infection and osteomyelitis, who underwent EGF in accordance with the study criteria. In our study, EGF of 75µg/day 3 times a week was applied intralesionally to diabetic ulcers for 4-8 weeks.
 Results: A total of 29 patients were included in the study. 21 of the patients were male and 8 of them were female. The mean age was 59,82. One patient had signs of osteomyelitis. Additional disease was detected in 93,1% of the patients. The mean ulcer width of the patients was found to be 3,44 cm2.
 Conclusion: Three important results were obtained from the study. First; epidermal growth factor has been quite effective in the treatment of patients with DFU. The second important finding was to ensure the safe epithelialization of the standing ulcers without impairing the quality of life of the patients. Thirdly, after debridement, treatment with EGF was found to provide a significant improvement in wounds.

Diabetic foot ulcers (DFU) are chronic complications due to poor diabetic control. Diabetic foot ulcers can lead to lifelong disability and substantially diminish the quality of life. The aim of this study was to carry out a thorough evaluation of diabetic foot ulcer management, compare current scenario of DFUs care with the International guidelines and to identify the extended roles of clinical pharmacist to improve the conditions of diabetic patient with foot ulcers. It is a retrospective qualitative study carried out in two tertiary care hospitals of Tamil Nadu state. The patients were selected based on inclusion and exclusion criteria admitted in the hospitals with diabetic foot ulcers. The patient’s sociodemographic and clinical characteristics tools from the patient medication records (PMR) were collected and taken into considerations for the study. The study revealed that diabetic foot ulcer was more prevalent among male patients with type 2 diabetes since 11 to 25 yrs belongs to the age group between 51-60 years. It was found that 60.5% of the patients having at least one co-morbid condition and 90.6% of patients possess one or more risk factors to develop diabetic foot ulcers. Glycated hemoglobin (HbA1c) test were done only by 54.7% of the patients, which showed that it was not insisted as an important identification tool for diabetic foot ulcer. The PMR revealed numerous antibiotics switch-over for the wound treatment as well. From the study it was concluded that an immediate requirement and thorough evaluation of enhanced foot care management, patient centered care and diabetic foot surveillance etc is needed for diabetic foot ulcer management. A comparative current scenario of DFUs care with the International guidelines and its adaptation and modifications according to our need is to be emphasized. Amalgamation of clinical pharmacy services with the multidisciplinary diabetic foot care team services is to be made. The clinical pharmacist’s intervention is to be put forward to improve the conditions of diabetic patient with foot ulcers to decrease the alarming incidences in Indian hospital settings. Key Words: Diabetes, diabetic foot ulcer, wounds, guidelines, clinical pharmacy intervention