Diabetic Hand Research Articles

Diabetic Hand Infections: Factors at Presentation Influencing Amputation and Number of Surgical Procedures.

Background Diabetic hand infections are associated with significant morbidity and disability. Amputations cause permanent disability, and multiple surgical procedures lead to morbidity. Diabetic foot infections have been well-studied but literature on hand infections is limited. We undertook a retrospective study of patients with diabetic hand infections operated at our center to study the factors at presentation with significant association with amputation and number of surgical procedures. Patients and Methods Demographic data of 51 patients was collected. The six parameters, namely, duration of diabetes, “onset of symptoms to presentation” interval, presence of comorbidities, HbA1c level, random blood sugar (RBS) levels at admission, and culture characteristics were selected for statistical analysis to find a relationship with the two outcome variables: number of procedures done and need for amputation. Results On bivariate analysis, Gram-negative infection was found to have a significant relationship with the need for multiple of procedures ( p = 0 . 014). The mean difference between the “onset of symptoms to presentation” interval between the amputation/non-amputation groups (2.9 days, p = 0 . 04) and the multiple procedures/non-multiple procedure groups (4.4 days, p = 0 . 02) was found to be statistically significant. Presence of comorbidities, long duration of diabetes, HbA1c, and RBS levels at admission did not show any statistically significant association with the two outcome variables studied. Conclusion In the present study, we found that infection with Gram-negative organisms is significantly related to the need for multiple surgical procedures. A delay in presentation can influence the risk of amputation as well as multiple procedures. Institution of early appropriate care is important to get a good outcome.

Five-year mortality rate for patients with diabetic hand gangrene who undergo upper extremity amputation.

The aim of this study was to describe the characteristics of patientsundergoing upper extremity amputation (UEA) for diabetic hand gangrene with aspecial focus on mortality and to determine the risk factors for thedevelopment of hand gangrene in diabetic patients. The medical records of patients who underwent lower extremity amputation (LEA) or UEA because of diabetic gangrene between January 2005 and December 2012 were retrospectively reviewed. Patients were then assigned to one of two groups: the UEA group (n = 15, 9 male; mean age = 62 ± 12.4) and the LEA group (n = 280, 196 male; mean age = 64.6 ± 10.9). A Kaplan-Meier analysis was performed to compare the five-year survival rates between the two groups. A multivariable logistic analysis including demographic characteristics, laboratory data, and dialysis status was conducted to identify the risk factors for diabetic hand gangrene. The five-year mortality rate in the UEA group (86.7%, 13 of 15 patients) was significantly higher than that in the LEA group (51.8%, 145 of 280 patients, P < 0.001). Dialysis status was determined as a risk factor associated with the development of diabetic hand gangrene (OR, 4.05; 95% CI, 1.23-13.29; P = 0.021). Evidence from this study has revealed that that amputation for diabetichand gangrene is associated with a high rate of mortality. Among diabeticpatients, the five-year survival rate of patients who underwent amputation fordiabetic hand gangrene was only 13.3%. Level IV, Prognostic Study.

Non-Tropical Diabetic Hand Syndrome in Peru: A Case Report

Background: The diabetic foot is the most studied spectrum in relation to musculoskeletal complications in diabetic patients but upper extremities may be affected, producing from superficial hand injuries to multiorganic failure due to sepsis. Tropical diabetic hand syndrome has been used to describe a potentially dangerous infection in the hand, generally diagnosed in areas of the tropics. Nevertheless, cases have been seen in non-tropical areas in marginal urban areas which are part of the spectrum of Non tropical diabetic hand syndrome.Clinical Case: A 52-year-old woman, from marginal urban area of Lima- Peru with type 2 diabetes mellitus (T2DM) of 6 years in poor metabolic control. She was admitted to the emergency room with two weeks of volume increase, erythema, purulent secretion, flogosis in the fifth finger of the left hand and fever. Initial tests confirmed mild diabetic ketoacidosis and sepsis (pH: 7.29; Glucose: 320 mg / dl, Bicarbonate: 15 mEq/L, Ketone bodies - urine (+), leukocytes 14360 cells/mm3, CRP: 180). Intravenous antibiotic was started. A surgical debridement and amputation of the fifth finger of the left hand was decided. Patient with unfavorable evolution, on the eight day, was admitted to new surgical debridement without clinical improvement. Arterial Doppler Ultrasound and CT angiography confirmed distal arterial insufficiency due to monophasic flow in the left ulnar artery with the presence of collateral circulattion. A third surgical debridement and amputation of the fourth finger of the left hand was done with favorable postoperative clinical evolution.Non tropical diabetic hand syndrome affects predominantly women, between 50 to 60 years, with low socio-cultural level and deficient glycemic control, as in case presented. Other factors include body mass index < 20kg/m2, DM 1 and diabetic neuropathy. Diabetic neuropathy is the most common risk factor in Non tropical diabetic hand syndrome cases, with a prevalence of 88%, while peripheral arterial disease was present in 11% of cases. In this report, neuropathy and peripheral arterial disease were present.Conclusion: Non tropical diabetic hand syndrome is uncommon and underdiagnosed complication of Diabetes Mellitus that has an important clinical repercussion as an important cause of disability. Detailed physical examination of the hands in a patient with diabetes for detection of these cases is highlighted because an early diagnosis and treatment improves prognosis.

Outpatient Management of Diabetic Hand Infections.

PurposeFor many providers, hand infections among diabetic patients is a condition that necessitates focused inpatient care. These patients are believed to have decreased innate immunity to fight infection, a more virulent course, and difficulty with recovery. Diabetes is considered by some to represent an additional risk factor that can result in an unfavorable outcome if not managed in an aggressive manner. Our own experience suggests that many of these patients can be safely managed in the outpatient setting. The purpose of this project was to better define the clinical outcomes for this population.MethodsEvidence-based criteria were utilized to direct inpatient versus outpatient treatment pathways. A database was developed to track hand infections treated by the specialty service. The primary outcome was the resolution of hand infection. Secondary outcomes included specific treatment responses as well as patient characteristic comparisons of the different treatment groups. Independent variables included (parenteral and enteral) antibiotic use and bedside interventions performed. Patients were followed to complete the resolution of infection.ResultsFor all patients managed as outpatients, diabetic patients had statistically significantly decreased improvement rates at two weeks as compared to non-diabetic patients (62% vs 75%, p =0.024). This difference disappeared at two months. Among diabetic patients, those with the highest rate of recovery at two weeks (90%) received intravenous antibiotics, bedside procedures, and oral antibiotics. Patients who did not receive antibiotics or undergo bedside procedures had the lowest percent of improvement (37%). Across all treatment subgroups, bedside procedure was the most impactful intervention. Less than 10% of patients were converted from outpatient to inpatient care, both diabetic and non-diabetic.ConclusionsWe reviewed our experience managing diabetes mellitus hand infections treated in the outpatient setting. Appropriate and effective treatment is possible, and the results are equivalent to those of patients without diabetes mellitus.

Prevalence of Reumatological Manifestations Among Diabetes Mellitus

Background: The Diabetes mellitus (DM) is a key secondary cause of many reumatological disorders especially osteoarthritis, shoulder hand syndrome, frozen shoulder, and trigger finger. Patients with diabetes commonly have Rheumatic complaints. They control good glycemic by doing exercises, following a diet, and taking medication which can improve or prevent the development of rheumatic conditions. Aim of study: The current study aims at finding the frequency of rheumatic situations for diabetes mellitus. Patients and methods: Hundreds of patients randomly were taken from the diabetic center of endocrinology at AL-Sadder teaching Hospital in Najaf city through the period of July 2010-March to 2011. Each patient subjected to complete clinical history, examinations, x-ray, height, weight and HbA1c measurement. Results: prevalence of rheumatological manifestations in diabetic patients was osteoarthritis (40%),diabetic hand syndrome (16.8%),frozen shoulder (12%), shoulder hand syndrome (12%),trigger finger(7.2%),diffuse idiopathic skeletal hyperostosis(6.4%),Depatterns contracture (4.8%) and Charcot, s joint (0.8%).There was a significant relationship between osteoarthritis, the syndrome of diabetic hand, diffusing idiopathic skeletal hyperostosis at p value 0.426,0.141,0.401,0.503,0.140 respectively among type 2 and type 1 diabetes mellitus . Conclusion: Rheumatological disorders are a common complication of diabetes mellitus. They are directly interrelated to patient’s age, span of diabetes mellitus. How to Cite this Article Pubmed Style Yaqoob Yousif Al-Kufi and Mohammad Abd Abdul-Hussain. of Reumatological Manifestations Among Diabetes Mellitus. SRP. 2020; 11(5): 721-727. doi:10.31838/srp.2020.5.103 Web Style Yaqoob Yousif Al-Kufi and Mohammad Abd Abdul-Hussain. of Reumatological Manifestations Among Diabetes Mellitus. http://www.sysrevpharm.org/?mno=126018 [Access: March 30, 2021]. doi:10.31838/srp.2020.5.103 AMA (American Medical Association) Style Yaqoob Yousif Al-Kufi and Mohammad Abd Abdul-Hussain. of Reumatological Manifestations Among Diabetes Mellitus. SRP. 2020; 11(5): 721-727. doi:10.31838/srp.2020.5.103 Vancouver/ICMJE Style Yaqoob Yousif Al-Kufi and Mohammad Abd Abdul-Hussain. of Reumatological Manifestations Among Diabetes Mellitus. SRP. (2020), [cited March 30, 2021]; 11(5): 721-727. doi:10.31838/srp.2020.5.103 Harvard Style Yaqoob Yousif Al-Kufi and Mohammad Abd Abdul-Hussain (2020) of Reumatological Manifestations Among Diabetes Mellitus. SRP, 11 (5), 721-727. doi:10.31838/srp.2020.5.103 Turabian Style Yaqoob Yousif Al-Kufi and Mohammad Abd Abdul-Hussain. 2020. of Reumatological Manifestations Among Diabetes Reviews in Pharmacy, 11 (5), 721-727. doi:10.31838/srp.2020.5.103 Chicago Style Yaqoob Yousif Al-Kufi and Mohammad Abd Abdul-Hussain. Prevalence of Reumatological Manifestations Among Diabetes Mellitus. Systematic Reviews in Pharmacy 11 (2020), 721-727. doi:10.31838/srp.2020.5.103 MLA (The Modern Language Association) Style Yaqoob Yousif Al-Kufi and Mohammad Abd Abdul-Hussain. Prevalence of Reumatological Manifestations Among Diabetes Mellitus. Systematic Reviews in Pharmacy 11.5 (2020), 721-727. Print. doi:10.31838/srp.2020.5.103 APA (American Psychological Association) Style Yaqoob Yousif Al-Kufi and Mohammad Abd Abdul-Hussain (2020) of Reumatological Manifestations Among Diabetes Reviews in Pharmacy, 11 (5), 721-727. doi:10.31838/srp.2020.5.103

Hydroxychloroquine used to treat diabetic hand syndrome: a case report

Increased incidence of musculoskeletal disorders has been linked with diabetes mellitus (DM). Focus of antidiabetic therapy is prominently towards controlling blood glucose levels along with prevention and management of micro- and macrovascular complications. These complaints often receive less attention and are undertreated. No specific drug treatment has been recommended for the management of musculoskeletal complications of DM. Hydroxychloroquine (HCQ) decreases joint inflammation and pain in rheumatoid arthritis (RA). In India, due to its proven antidiabetic effect, it is officially approved for the management of type 2 diabetes mellitus (T2DM). Due to its anti-inflammatory and antidiabetic effect, it may alter the clinical course of musculoskeletal complications in T2DM patients. We report a case of 55-year-old male patient, diagnosed with T2DM since last 6 years. The patient had bilateral musculoskeletal involvement of upper extremities at the time of presentation. He had difficulty in moving smaller joints of hand, closing of fist and trigger finger, all suggestive of diabetic hand syndrome. Good improvement in joint mobility was observed after initiation of HCQ 400 mg once daily as add-on to existing antidiabetic regimen. HCQ was found to be effective in relieving symptoms of musculoskeletal complications as well as controlling blood glucose level in our patient. More clinical studies investigating use of HCQ in diabetic musculoskeletal complications are warranted.

Ultrasound-guided intervention and hand tenosynovitis in patients with diabetes mellitus

Background: Flexor tenosynovitis is a frequent cause of hand pain in diabetic patients, and corticosteroid (CS) injection is usually efficiently used in the treatment protocol. Ultrasound (US) guidance is usually helpful for accurate needle placement and improves the outcome. Aim of the Work: The aim of the work was to evaluate the efficacy of US-guided injections compared to clinically guided injections, the treatment of flexor tenosynovitis in diabetic hands. Patients and Methods: Patients were divided into two matched groups of diabetic patients with flexor tenosynovitis: Group 1 – treated with local CS injection under US guidance and Group 2: treated with local CS injection under clinical guidance. Both the groups were assessed twice for pain and tenderness using visual analog scale (VAS) and Richie index, respectively, one before the injection and the second 1 month after. All affected tendons were assessed and graded by US and power Doppler at baseline and 1 month after the injection. Results: Both the groups were matched as regards the disease duration, age, and glycated hemoglobin A1c. The mean VAS for Group 1 was 8.1 ± 0.8 cm at baseline and 3.4 ± 0.7 cm in the second visit; greyscale US showed improvement in 16 patients (61%). The mean VAS was 8.3 ± 0.7 cm at visit one, while it dropped down to 4.5 ± 0.9 cm in visit two. Conclusion: US-guided injections of CSs are statistically superior to clinically guided in treating flexor tenosynovitis in diabetic patients.

O que significa “Mão Diabética” e qual o papel da Saúde Ocupacional?

Introduction / background / objective As the workforce ages and rates of metabolic diseases increase, it is likely that more cases of “diabetic hand” manifestations will appear in Occupational Health services. While some health professionals know how to quickly track the “diabetic foot”, the “diabetic hand” is often undervalued, diagnosed in isolation, without recognition or association with the high prevalence of metabolic syndrome, especially in the Western world. These manifestations have an impact on functionality, and inevitably affect work performance, and should be subject to screening, monitoring and intervention by occupational health teams, in order to enhance the function and minimize the negative impacts that they cause both individually and collectively. Thus, the main objective of this work is to elaborate a review on the concept of “diabetic hand” and what is the implication that it can have in the worker’s health and Occupational Health practice. Methodology It is a Scoping Review, initiated through a search in the PUBMED (Medline), EBSCO (Cinahl; Medline; Cochrane; Library Information Science &amp; Technology Abstracts; Nursing Allied Health Collection; MedicLatina) and RCAAP databases, conducted in the months of July and August of 2020, covering all articles (in Portuguese and English languages), with no limit of time, that could explain the concept of diabetic hand. The search words used were: “diabetic hand” ou “cheiroarthropathy”. Results Several conditions have been linked to the concept of diabetic hand, namely cheiroarthropathy (limited joint mobility and stiffness), Dupuytren’s contracture, trigger finger (flexor stenosing tenosynovitis), and carpal tunnel syndrome. Conclusions These manifestations share mechanisms with the classic complications of diabetes, and the recognition that microvascular changes occur concomitantly may provide insights for early screening of metabolic biomarkers. Acknowledging so can contribute to reduce disability (delay hand and fist related manifestations’ progression), and also to reduce future morbidity of workers (minimizing the risks of metabolic diseases), helping to maintain a more capable and productive workforce, where corrective measures and early treatments can be implemented. The diabetic hand may be a concept of interest, then can be further addressed soon, as the complications of metabolic syndrome (and associated comorbidities) increase worldwide.

Effect of Hand Rehabilitation on Hand Grip Strength and Manual Dexterity in Patients with Diabetic Hand Syndrome

Background- In patients with diabetes upper extremity impairments are common. Diabetes patient are more prone to diabetic hand. Aim- To study the effect of hand exercises on hand grip strength and manual dexterity in patients with Diabetic hand .Objectives- To study the effect of hand exercises on hand grip strength in patients with Diabetic hand using Modified sphygmomanometer test. To study the effect of hand exercises dexterity in patients with Diabetic hand using grip ability scale. To study the effect of hand function in patients with Diabetic hand using Michigan hand outcomes questionnaire (MHQ) and Duruoz Hand Index. Setting and design – In this study 15 individual participated having diabetic hand which was selected randomly. Modified sphygmomanometer test was performed on patient to check grip strength. Grip ability scale was performed on patient to check manual dexterity. Hand function was check using Michigan hand outcomes questionnaire (MHQ) and Duruoz Hand Index. The effect of hand exercise on hand grip strength and manual dexterity in patients with diabetic hand was analysied. Result- Total 15 individual participated with age mean 58±13.519 and duration of diabetes with mean 11±6.448. Modified sphygmomanometer test result improved from 28.13±3.044 to 32.47±2.875(p=0.001). Grip ability test result improved from 23.13±3.523 to 18.67±1.345(p=0.001). Michigan hand outcome questionnaire result improved from 53.29±10.19 to 71.34±5.036(p=0.001). Duruoz Hand Index result improved from 31.67±11.2 to13.47±4.596(0.001).Conclusion- There is significant effect of hand exercises on hand grip strength and manual dexterity in patient with diabetic hand.

Musculoskeletal manifestations among diabetic patients in Saudi Arabia.

Context:Diabetes mellitus (DM) is one of the most common diseases worldwide. Patients with DM are prone to develop multiple musculoskeletal (MSK) manifestations, which may lead to disability and an impact on patients’ quality of life. These manifestations include but not limited to, adhesive capsulitis, shoulder hand syndrome, diabetic hand syndrome, diffuse idiopathic skeletal hyperostosis, Dupuytren's contracture.Aims:The aim of this study is to assess the prevalence of MSK manifestations in diabetic patients in Saudi Arabia.Settings and Design:The study was carried out in NGHA hospital and PHC in Saudi Arabia.Methods and Materials:This is a retrospective study carried out between 2015 and 2019 where all patients with DM type II between the age of 18 and 65 and were diagnosed with MSK manifestations included in the study.Statistical Analysis Used:Statistical Package for the Social Sciences (IBM-SPSS) software (Version 23).Results:A total of 208 patients were found to have MSK manifestations. The average age of patients was 53 years old ranging from (31-63). The mean reading of A1C was 8%. A total of 34.1% were controlled and 65.9% were uncontrolled. Carpal tunnel syndrome (CTS) was found in 10%. Adhesive capsulitis in 2.4%. Septic arthritis in 1%. Trigger finger was found in 7.2%. Osteomyelitis was found in 0.5%. Plantar fasciitis was found in 4.8%. Osteoarthritis (OA) was found in 149 subjects (71.3%). Two subjects had ankle OA, one hand OA, nine shoulder OA, one hip arthritis. The rest had knee OA. Rotator cuff tendonitis was found in 1%. No significant correlation between age, A1c and all the MSK manifestations that were mentioned above (P value >0.05).Conclusions:MSK manifestations are common among diabetic patients. OA was the most frequently seen disorder. Physicians should be aware of the high prevalence and the huge impact on patients when treating patients with type II DM.

Tropical diabetic hand syndrome: case report of successfully salvaged threatened dominant hand

Tropical diabetic hand syndrome (TDHS) is a less well-recognized complication of diabetes. It is characterized by cellulitis of hand and ends up with limb threatening significant tissue loss, sepsis and in occasion death. When the joint capsule and tendons are exposed in TDHS the digits and the limb and function of the hand are threatened. Loss of thumb of the dominant hand leads to devastating disability. The current case describes successfully managed case of TDHS with threatened thumb and function due to exposed first metacarpophalangeal joint and extensor tendons of the dominant hand.

Is the Preoperative Glycated Hemoglobin (HbA1c) Level Predictive of the Severity of Diabetic Hand Infection According to Surgical and Clinical Outcomes?

We purposed to investigate whether preoperative HbA1c level is associated with the severity of surgical treatment in diabetic hand infection cases. Between December 2015 and October 2018, 102 patients were surgically treated due to diabetic hand infection. Of the patients, 75 who met the criteria for diabetic hand infection were included in the study. The patients were divided into two groups: Group 1, < 8.5% HbA1c level (poorly controlled); and Group 2, 8.5% or higher HbA1c level (uncontrolled). Preoperative, intraoperative, and postoperative data were recorded. Drainage, VAC, ray/open amputation, and microsurgical reconstruction were performed according to the examination and clinical findings. p<0.05 was considered statistically significant. The study groups consisted of 41 patients (5 female/36 male; median age 59 years, range 32-68) in Group 1 and 34 patients (6 female/28 male; median age 62 years, range 28-67) in Group 2. The mean follow-up period was 21.14±10.42 months in Group 1 and 16.70±10.19 months in Group 2, which were not significantly different (p>0.05). The most common microbiological pathogen was polymicrobial in both study groups (39% in Group 1 and 41.2% in Group 2). Drainage was the most common surgical procedure in both groups and there was no significant difference between the groups in terms of the surgical techniques that were used (p>0.05). Although HbA1c level is an important biomarker for monitoring glycemia in diabetic patients, it is not associated with the severity of surgical treatment in diabetic hand infections.

Evaluation of hot and cold sensation of hand in type 2 diabetic patients in age group of 40-80 years

Introduction: The aim of the study is to find out the effect of Type 2 diabetes (T2DM) on the hot and cold sensation of hand. Material and Method: Total100 subjects in the age group of 40-80 year, both male and female were included in this study. Subjects were divided into 2 groups. Group A: 50 subjects diagnosed type 2 diabetic mellitus. Group B: 50 normal healthy subjects investigated and diagnosed Non-diabetic mellitus. Before the start of the procedure, detailed neuro-musculoskeletal evaluation was done to meet inclusion and exclusion criteria and those who were ready to be part of the study, the written informed consent was obtained from them. Rolyan hot and cold discrimination kit was used to examine hot and cold sensation of both handsat pulp of index finger, little finger and dorsal web space. Result: There was loss of hot & cold sensation in 10% subjects of T2DM group at index and little finger bilaterally and all these subjects have the duration of diabetes >15yr. Conclusion: loss of sensation may lead to injuries of diabetic hands. Hand care should be thought to the patients to prevent injuries to the hand. Keywords: Type 2 diabetes, Hot and cold sensation, Diabetic hand.

Surgical outcomes of diabetic hand infections in Lagos, Nigeria.

Hand infections in diabetics can be a major cause of functional impairment. In patients with Tropical Diabetic hand syndrome prompt surgical intervention may salvage the hand, but return to premorbid function remain a challenge. A retrospective study of consecutive diabetic patients with hand infections was done in 2 tertiary institutions in Lagos, Nigeria to identify the epidemiology, modes of presentation, types of surgical intervention and outcomes of treatment. Twenty one patients were studied over a 5 year period. ten males, eleven females. All were type 2 Diabetes. 52.4%(11) were diagnosed less than a year prior to presentation. 61.9%(13) had digit/hand gangrene on presentation. All operated patients (20) had wound debridements. 52.5% (11) digit/hand amputations and this was the commonest surgical procedures done. Other surgeries done include skin grafts and `flap reconstructions. There was a 19% mortality rate. Less than a fifth were able return to their premorbid occupation after 3 months. But all had reduced range of motion in the interphalangeal joints in the adjacent digits. There is a high morbidity rate for hand infections in the diabetic, even though majority of the hands were salvaged, most patients were unable to return to their premorbid occupation at 3 months.

Diabetic Hand Infection: An Emerging Challenge.

Background: Hand infection in diabetics is an often ignored but challenging condition. If not addressed effectively, it may result in long term disability, contracture, amputation and even death. Methods: From August 2014 to December 2015, a study was done in our centre, where 49 diabetic hand infection cases were analyzed in two groups, superficial and deep hand infection. Results: Mean age of the patients was 51.63 years. There were 21 superficial infections and 28 deep infections. Cause of infection was unknown or spontaneous in 16 cases, traumatic laceration or crush in 14 patients, following minor prick in 10 cases. Most of the cases were the results of neglected minor wound. Forty-one patients were insulin dependent. Five cases were diagnosed as diabetic at the time of treatment. Four patients were treated conservatively and 45 (92%) cases required operation in the form of incision, drainage and debridement. In 16 (35%) cases, wound was left open and was healed by secondary intention following regular dressing. In five patients, wound was closed secondarily. Partial thickness skin graft was applied in 15 cases. Seven patients were treated with flap coverage. Partial digital or ray amputation were done in 16 cases. All fingers except thumb were amputated in one case and amputation from wrist was done in another patient. Wound swabs were taken, and antibiotics were changed or continued accordingly. But reports of 26 cases were available. No growth was found in four cases, monomicrobial infection was found in 15 patients and polymicrobial in seven cases. Infection resolved with healing in 47 cases. Two patients died during treatment from sepsis, both were insulin dependent, had associated renal failure and from deep infection group. One patient developed severe mental disorder. Conclusions: For diabetic hand infection, early diagnosis and prompt treatment with appropriate antibiotics and emergency surgery with extensile incision is crucial. Primary amputation of the part could be life and limb saving.

Effects of a task-based biofeedback training program on improving sensorimotor function in neuropathic hands in diabetic patients: a randomized controlled trial.

Symptoms of diabetic hands have been gradually elucidated, however the interventions for these hand problems are typically underemphasized. Few studies have discussed intervention effects on sensorimotor problems in hands, which prevent diabetic patients from executing their daily routines and lower their quality of life (QoL). This study has investigated the effects of task-based biofeedback training compared with home-based programs on sensorimotor function and QoL in diabetic patients with neuropathic hands. A single blind randomized controlled trial. Outpatient clinic at a university hospital. Thirty-eight patients with diabetic hand neuropathy whose sensorimotor functions were impaired based on screening with a pinch-holding-up activity (PHUA) test. Participants were randomly assigned to either a computerized evaluation and re-education biofeedback (CERB) (N.=20) or a home-based (tendon gliding exercise in conjunction with resistive exercise) (N.=18) group. The primary outcome was sensorimotor control of a hand using the PHUA test. Secondary outcomes included changes in Semmes-Weinstein monofilament, two-point discrimination, the Purdue Pegboard test and a self-reported QoL questionnaire. The measurements were conducted before and after a 6-week treatment program. The CERB group significantly improved efficiency in pinch force output during the PHUA test by reducing the percentage of maximum pinch strength (change from 34.5±11.66 to 30.7±10.16%, P=0.001), and there was a statistically significant between-group difference (P=0.00, 95% CI: -12.59 to -3.34, F=9.42). The CERB group showed superior treatment effects as compared to the control group on the two-point discrimination results (P=0.01) as well as the pin insertion subtests in the Purdue pegboard test (P=0.01). The QoL results also revealed significant between-group differences in several items of the Diabetes-39 (P<0.05). This study showed that a task-based biofeedback training program provides superior benefits for restoration of hand sensorimotor functioning in diabetic patients as compared to a home-based program combining tendon gliding exercise and resistive exercise. Using task-based biofeedback training as one of the rehabilitation strategies may be an effective approach for restoration of sensory function, precision pinch performance, hand dexterity, and QoL for patients with diabetes-related neuropathy.

Diabetic hand: an entity more common than thought

Diabetic hand: an entity more common than thought

Inguinal Flap Implementation In Diabetic Hand Infection With Complicated Invasive Candidiasis

Inguinal Flap Implementation In Diabetic Hand Infection With Complicated Invasive Candidiasis

The diabetic hand: a very neglected pathology A Case Study &amp; Review of Literature

The diabetic hand: a very neglected pathology A Case Study &amp; Review of Literature

Hand infection in patients with diabetes: a series of 17 cases and a pooled analysis of the literature

Background/aim: The aim of this study was to report the clinical characteristics and the treatment outcomes of hand infections in diabetic patients and to review the literature. Materials and methods: The medical records of 17 patients with diabetic hand infections admitted to the Diabetic Foot Care Center of two different clinics from January 2012 to October 2017 were reviewed. To perform the pooled analysis, published series (32 studies) were searched in two international databases (www.scopus.com and www.pubmed.com). Results: Of the 17 patients (mean age 61.7 ± 8.5 years), 8 (47.1%) were female. All cases were type 2 diabetes mellitus. The mean duration of diabetes was 9.0 ± 5.96 years and the mean HbA1c was 7.86 ± 1.88%. There was necrosis in 8 patients (47.1%). The most common causes were injury during saw and hammer use in 5 patients (29.4%) and injury due to inappropriate nail cutting in 3 patients (17.6 %). Nine (52.9%) patients were operated on. No patients underwent any major amputations or died. In 32 publications, 704 patients with diabetic hand infections were found. The average age was 53.43 years (n = 591) and 84.29% of patients (322/382) were found to have type 2 DM. The mean duration of diabetes was 4.12 years (n = 317) and the mean HbA1c was 10.58% (n = 140). The rate of surgical operation was 74.59% (323/433). Conclusion: Diabetic hand injuries often occur when using hand tools such as hammers, saws, and knives, and when cutting nails. It is necessary to use conservative treatment rather than amputation. These patients should consult experienced health care professionals.