Diabetic Foot Patients Research Articles

Association between sarcopenia and the foot-ankle function in type 2 diabetic foot ulcer

BackgroundThe diabetic foot (DF) ulcer is the severe complication of type 2 diabetes mellitus (T2DM). Sarcopenia is characterized as the loss of muscle mass and strength, resulting in the increased risk of fracture and physical disability. Sarcopenia may affect the foot-ankle function in DF ulcer patients, compromise the quality of life.ObjectiveThe aim was to clarify the effect of sarcopenia on foot-ankle function in patients with DF ulcer.MethodsIn total of 108 T2DM patients with DF ulcer were enrolled. Based on the examination of muscle mass by dual energy X-ray absorptiometry (DXA) and grip strength and 5x sit-to-stand test, the DF patients were divided into sarcopenia and non-sarcopenia groups. The severity of DF ulcer was evaluated by Wagner classification. The foot-ankle function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score.ResultsDF patients with sarcopenia showed advanced age, lower BMI, longer duration of T2DM, and more severe Wagner classification, reduced appendicular skeletal muscle mass index (ASMI), grip strength, transcutaneous oxygenpressure (TcPO2) and prolonged time of 5X sit-to-stand test. The stratified comparison analysis indicated that severity of sarcopenia and DF ulcer, reduced TcPO2, and grip strength were aggravated with the impaired foot-ankle function (P < 0.05). Multivariate Logistic analysis showed that age, TcPO2, and severe sarcopenia were risk factors deteriorating the foot-ankle function.ConclusionThe sarcopenia is a key risk factor of decreasing foot-ankle function in patients with DF ulcer. Thus, the prevention of muscle mass and strength loss could be considered as part of comprehensive therapy for DF ulcer.

Foot Sole Temperature Correlates with Ankle-Brachial Index, Pulse Wave Velocity, and Arterial Age in Diabetic Patients Without Diagnosis of Peripheral Arterial Disease.

Background/Objectives: Some vascular alterations such as peripheral arterial disease (PAD) or arterial stiffness can alter perfusion of the limbs, so we wondered if this is reflected in the temperature of the soles of the feet of diabetic patients who did not have a diagnosis of peripheral arterial disease. Foot sole temperature was correlated with the ankle-brachial index (ABI), carotid-femoral pulse wave velocity (cfPWV), brachial-ankle pulse wave velocity (baPWV), and arterial age. Methods: A total of 175 patients with type 2 diabetes mellitus, without a previous diagnosis of PAD, were recruited. Comorbidities, anthropometry, biochemical analysis results, temperature, ABI, cfPWV, baPWV, and arterial age were recorded. Forty-two temperature records were obtained from the sole of the foot with an FLIR T865 thermal imaging camera. ABI, cfPWV, baPWV, and arterial age were obtained using plethysmographic and oscillometric methods. Statistical analysis was performed with SPSS v.29.0 (correlations and multiple linear regression models). Results: All temperature points analyzed correlated negatively with ABI (p < 0.001) and rho values ranged from -0.168 to -0.210. Likewise, cfPWV, baPWV, and arterial age had similar results, since most temperature records showed low rho values and a negative correlation with these parameters. Four models were developed to explain the variables of interest. Temperature was involved in all of them. The temperature of the first toe was included in the prediction of cfPWV, baPWV, and arterial age. Conclusions: There is an inversely proportional relationship between temperature and ABI, cfPWV, baPWV, and arterial age in diabetic patients without a previous diagnosis of arterial disease. Temperature can be a predictor of these hemodynamic variables.

Study on the mechanism of activating SIRT1/Nrf2/p62 pathway to mediate autophagy-dependent ferroptosis to promote healing of diabetic foot ulcers.

Diabetic foot (DF), a prevalent and grave diabetes sequela, is considered as a notable clinical concern, with SIRT1 downregulation observed in DF patients' blood specimens. Nonetheless, the regulatory mechanisms of SIRT1 in diabetic foot ulcer (DFU) remain unclear. Thus, in the current study, we investigated the role and mechanisms of SIRT1 in alleviating DFU. Western blotting was used to detect the expression of autophagy and ferroptosis-related proteins, CCK8 assay was used to measure cell proliferation. Plate colony method was used to measure bacterial growth, and the inhibitory effect on intracellular and extracellular Staphylococcus aureus was observed after drug intervention. ELISA was used to detect inflammatory cytokines and oxidative stress markers levels. ROS, total iron, and Fe2+ levels were detected using corresponding assays. Additionally, HE staining detected the thickness of the epidermis and dermis of the rat wound tissue while the collagen deposition in the wound tissue was detected using Masson staining. In addition, Prussian blue staining was used to detect iron deposition, and C11 BODIPY 581/591 lipid peroxidation probe was used to detect lipid ROS. Our results suggested that the activation of SIRT1/Nrf2/p62 signaling affects cell proliferation, colony formation, ferroptosis, and the production of lipid ROS in DFU-infected cell model through autophagy. In vivo experiments indicated that activating SIRT1/Nrf2/p62 signaling affects oxidative stress, inflammation, and autophagy in wound tissue and promotes wound healing in DFU rats through mediating autophagy-dependent ferroptosis. Taken together, the activation of SIRT1/Nrf2/p62 pathway can promote DFU healing, which might be mediated by autophagy-dependent ferroptosis.

Exploration of predictive risk factors for diabetic foot in patients with diabetes in Beijing: analysis of 5-year follow-up data of patients with diabetes mellitus in a single center in Beijing.

Large-scale prospective cohort studies on diabetic foot ulcers risk factor screening in China are limited. Therefore, this prospective cohort study aimed to explore the predictive risk factors for diabetic foot ulcers to provide clinicians with concise and effective clinical indicators for identifying a high-risk diabetic foot and guiding the prevention of diabetic foot ulcers. Patients with diabetes who visited the Department of Endocrinology of Peking University First Hospital from October 2017 to December 2018 were selected as research participants by convenience sampling. A total of 968 patients were included. After enrollment, a dedicated person collected and recorded all baseline data. A dedicated telephone follow-up was conducted every 12-24 months to evaluate whether the endpoint event had occurred. All patients were followed up for an average of 61 (57-71) months, with 95% of them followed up for more than 60 months. According to the occurrence of endpoint events, they were divided into the DFU and non-DFU groups. The data between the two groups were analyzed using independent-sample t-test, Wilcoxon rank sum test, and chi square test. We used univariate and multivariate logistic regression analysis to analyze the factors that affected the occurrence of diabetic foot ulcers. After the 5-year follow-up, the incidence of diabetic foot was 25.83%. Multivariate logistic regression analysis revealed that body mass index (odds ratio: 1.046; 95% confidence interval: 1.001-1.093), abnormal pinprick sensation (odds ratio: 4.138; 95% confidence interval: 1.292-13.255), history of fungal foot infection (odds ratio: 2.287; 95% confidence interval: 1.517-3.448), abnormal 128-Hz tuning fork test (odds ratio: 2.628; 95% confidence interval: 1.098-6.294), and HbA1c≥ 8% (odds ratio: 1.522; 95% confidence interval: 1.014-2.284) were independent predictors of diabetic foot. Our study highlights clinically relevant indicators that may help to prevent the occurrence of diabetic foot and guide timely interventions.

Leveraging smart image processing techniques for early detection of foot ulcers using a deep learning network.

To detect foot ulcers in diabetic patients by analysing thermal images of the foot using a deep learning model and estimate the effectiveness of the proposed model by comparing it with some existing studies. Open-source thermal images were used for the study. The dataset consists of two types of images of the feet of diabetic patients: normal and abnormal foot images. The dataset contains 1055 total images; among these, 543 are normal foot images, and the others are images of abnormal feet of the patient. The study's dataset was converted into a new and pre-processed dataset by applying canny edge detection and watershed segmentation. This pre-processed dataset was then balanced and enlarged using data augmentation, and after that, for prediction, a deep learning model was applied for the diagnosis of an ulcer in the foot. After applying canny edge detection and segmentation, the pre-processed dataset can enhance the model's performance for correct predictions and reduce the computational cost. Our proposed model, utilizing ResNet50 and EfficientNetB0, was tested on both the original dataset and the pre-processed dataset after applying edge detection and segmentation. The results were highly promising, with ResNet50 achieving 89% and 89.1% accuracy for the two datasets, respectively, and EfficientNetB0 surpassing this with 96.1% and 99.4% accuracy for the two datasets, respectively. Our study offers a practical solution for foot ulcer detection, particularly in situations where expert analysis is not readily available. The efficacy of our models was tested using real images, and they outperformed other available models, demonstrating their potential for real-world application.

Development of a prediction model for incidence of diabetic foot in patients with type 2 diabetes and its application based on a local health data platform

Objective: To construct a diabetes foot prediction model for adult patients with type 2 diabetes based on retrospective cohort study using data from a regional health data platform. Methods: Using Yinzhou Health Information Platform of Ningbo, adult patients with newly diagnosed type 2 diabetes from January 1, 2015 to December 31, 2022 were included in this study and divided randomly the train and test sets according to the ratio of 7∶3. LASSO regression model and bidirectional stepwise regression model were used to identify risk factors, and model comparisons were conducted with net reclassification index, integrated discrimination improvement and concordance index. Univariate and multivariate Cox proportional hazard regression models were constructed, and a nomogram plot was drawn. Area under the curve (AUC) was calculated as a discriminant evaluation indicator for model validation test its calibration ability, and calibration curves were drawn to test its calibration ability. Results: No significant difference existed between LASSO regression model and bidirectional stepwise regression model, but the better bidirectional stepwise regression model was selected as the final model. The risk factors included age of onset, gender, hemoglobin A1c, estimated glomerular filtration rate, taking angiotensin receptor blocker and smoking history. AUC values (95%CI) of risk outcome prediction at year 5 and 7 were 0.700 (0.650-0.749) and 0.715(0.668-0.762) for the train set and 0.738 (0.667-0.801) and 0.723 (0.663-0.783) for the test set, respectively. The calibration curves were close to the ideal curve, and the model discrimination and calibration powers were both good. Conclusions: This study established a convenient prediction model for diabetic foot and classified the risk levels. The model has strong interpretability, good discrimination power, and satisfactory calibration and can be used to predict the incidence of diabetes foot in adult patients with type 2 diabetes to provide a basis for self-assessment and clinical prediction of diabetic foot disease risk.

Comprehensive nursing model for diabetic foot ulcers: A strategy to improve prognosis and quality of life.

Diabetic foot (DF) ulcer is one of the common complications of diabetic patients, with high incidence and amputation rate, which seriously affects the quality of life and health of patients. Therefore, how to effectively prevent and treat DF ulcers and reduce amputation rate has become an urgent problem in the medical field. As a comprehensive nursing model for patients with DF ulcers, comprehensive nursing intervention is designed to improve the therapeutic effect and prognosis and reduce the rate of amputation. Convenient sampling method was used to select 360 patients with DF who received routine care for DF ulcers from July 2013 to July 2023 for retrospective cohort analysis. According to the existence of exposure factors (comprehensive nursing intervention), 180 cases were divided into observation group and comparison group. The basic demographic data, amputation rate, severity of foot ulcer, neuropathy and vascular disease, and blood glucose control were compared between the 2 groups. The data was analyzed using SPSS26.0. Harman single factor test was used to check whether there was common method bias in the study data. Descriptive analysis, Spearman rank correlation analysis and multiple linear regression analysis were used to analyze the current situation of amputation rate of DF patients and the influence of comprehensive nursing intervention on the amputation rate of DF patients. The amputation rate was 2.8% in the Observation group compared to 8.3% in the Comparison group. The amputation rate of the observation group was generally higher in the age group, and the amputation rate of the observation group was higher in the middle school education level and below and the economic status of <5000 yuan. The difference was statistically significant (P < .05). Age (odds ratio [OR] = 1.96; 95% confidence interval [CI]: 0.88-4.38), education level (OR = 1.30; 95% CI: 1.69-6.46), economic status (OR = 2.28; 95% CI: 1.69-10.85) was an independent risk factor for amputation rate (P < .05). Comprehensive nursing interventions have played a positive role in reducing the rate of amputation in patients with DF.

Autologous Platelet-Rich Gel Accelerates Diabetic Wound Healing Through Inhibition of Ferritinophagy.

Aims: The objective was to examine the efficacy of autologous platelet-rich gel (APG) in treating diabetic wound and investigate the association between APG and ferritinophagy. Methods: A total of 32 patients with diabetic foot (DF) and Wagner grade 1 to 2 were included. Within the APG group, individuals with DF received weekly APG treatment. In the non-APG group, DF patients received daily dressing changes. Flow cytometry quantified the proportion of endothelial progenitor cells (EPCs) in peripheral blood on days 0 and 10. The diabetic rat model was induced using Streptozotocin. Two circular skin wounds were created on the backs of rats. The normal glucose group received daily dressing changes on the wound. In the diabetic group, the left wound underwent daily dressing changes, whereas the right wound was treated with APG once a week. CD34 levels were tested 7 days after the skin damage. The levels of glutathione peroxidase 4 (GPX4), Nuclear Receptor Coactivator 4 (NCOA4), Light chain 3 (LC3), and Masson staining were quantified on 14 days. The wound area and wound healing rate were separately measured at 0 and 14 days after the injury, regardless of DF patients or diabetic rats. Results: The wound healing rate was higher in the APG group than in the non-APG group, regardless of DF patients or diabetic rats. The APG group had a greater ΔEPCs% in DF patients than the non-APG group. Regarding rat experiment, the APG group exhibited lower levels of NCOA4, and LC3 expressions and a shorter wound healing time. However, the APG group showed higher levels of CD34 expression, GPX4 protein, and collagen fibers than the non-APG group. Conclusions: Autologous platelet-rich gel accelerated the wound healing rate in diabetic populations and rats. Autologous platelet-rich gel promoted EPCs counts, collagen fiber volume, and vessel numbers. Autologous platelet-rich gel decreased LC3 and NCOA4 expression, but increased GPX4 protein expression. The possible mechanism was the inhibition of ferritinophagy.

Risk factors and surgical outcomes of diabetic foot in patients with diabetes at larribere clinic in oran university hospital

Risk factors and surgical outcomes of diabetic foot in patients with diabetes at larribere clinic in oran university hospital

γδ T cells are crucial effectors of antibacterial response in T2D complicated with diabetic foot

Abstract Nearly half a billion people worldwide have type 2 diabetes (T2D), which poorly controlled may lead to severe consequences, including diabetic foot. Growing evidence highlights the role of γδ T subsets in the antibacterial response. A total of 70 patients were divided into three groups: T2D, T2D with diabetic foot (DF), and individuals without T2D. Flow cytometry was used to assess the frequency of peripheral blood γδ T along with activation (CD69, CD56) and senescence (CD57) markers. Intracellular expression of cytokines was tested on peripheral γδ T and Vδ2 in vitro cultures. PBMCs were stimulated with S. aureus and P. aeruginosa lysates and the expression of CD25, HLA-DR, along with CD137, CD154 on Vδ1 and Vδ2 cells was determined. The predominance of the Vδ2 was observed in DF group. γδ T cells in DF patients were significantly activated, as evidenced by CD69 and CD56 expression. Moreover, upon phosphoantigen stimulation, both peripheral and zoledronate-derived Vδ2 exhibited increased levels of intracellular IL-17A and TNF compared to patients without T2D. The γδ T cell responses to bacterial lysates were more pronounced in Vδ2 than in Vδ1 cells within the DF group. Among Vδ1 cells more of them were CD137 positive than Vδ2. Overall, the data show differentiated antibacterial properties of Vδ1 and Vδ2 cells in T2D patients. Understanding of the role of γδ T cell subpopulations may improve the prevention of T2D complications.

Coexistence of Diabetic Retinopathy and Diabetic Foot in Patients Admitted at Indoor Facility of a Tertiary Care Center

Purpose: To determine frequency of “diabetic retinopathy (DR)” in patients admitted at a tertiary care hospital with diabetic foot. Study Design: Cross sectional study. Place and Duration of Study: HBS medical and dental college, Islamabad from November 2022 to November 2023. Methods: Sixty two patients admitted with “diabetic foot ulcer”(DFU) were included in this study. Severity of DFU was assessed using . Patients were assessed for presence of “diabetic retinopathy (DR)” as well as its severity. Data was analyzed using SPSS 22. Results: Mean age was 49.37 ± 11.02 years. There were 34 (54.84%) males and 28 (45.16%) females. Mean HbA1C% was 9.46 ± 1.11%. Mean duration of diabetes was 10.06 ± 5.53 years. Forty five percent patients had diabetic retinopathy (DR). Amongst these patients diagnosed with DR (n = 45), 6 (13.33%) had mild non-proliferative DR, 20 (44.44%) had moderate non-proliferative DR, 14 (31.11%) had severe non-proliferative DR and 5 (11.11%) had proliferative DR. According to Wagner Grade there were 32 (51.61%), patients with grade 2 DFU, 19 (30.65%) had grade 1 and 11 (17.74%) had grade 3. Coexistence of diabetic retinopathy and diabetic foot in patients admitted at indoor facility was 72.58%. Conclusion: Prevalence of “diabetic retinopathy (DR)” in patients admitted with diabetic foot was 72.58%. Presence of diabetic foot can be considered as strong predictor of presence of concomitant “diabetic retinopathy”.

Amide proton transfer weighted contrast has diagnostic capacity in detecting diabetic foot: an MRI-based case-control study.

To evaluate the role of foot muscle amide proton transfer weighted (APTw) contrast and tissue rest perfusion in quantifying diabetic foot (DF) infection and its correlation with blood parameters. With approval from an ethical review board, this study included 40 diabetes mellitus (DM) patients with DF and 31 DM patients without DF or other lower extremity arterial disease. All subjects underwent MRI, which included foot sagittal APTw and coronal arterial spin labeling (ASL) imaging. The normalized MTRasym (3.5 ppm) and the ratio of blood flow (rBF) in rest status of the affected side lesions to the non-affected contralateral side were determined. The inter-group differences of these variables were evaluated. Furthermore, the association between normalized MTRasym (3.5 ppm), rBF, and blood parameters [fasting blood glucose (FBG), glycosylated hemoglobin content, C-reactive protein, neutrophil percentage, and white blood cell count] was explored. Using an ROC curve, the diagnostic capacity of normalized MTRasym (3.5 ppm), BF, and blood biochemical markers in differentiating with or without DF in DM was assessed. In the DF group, MTRasym (3.5 ppm) and BF in lesion and normalized MTRasym (3.5 ppm) were higher than those in the control group (p < 0.05). In addition, correlations were identified between normalized MTRasym (3.5 ppm) and blood parameters, such as C-reactive protein, glycosylated hemoglobin content, FBG, neutrophil ratio, and white blood cell (p < 0.001). Meanwhile, association between BF in lesion and blood parameters, such as C-reactive protein, neutrophil percentage, and FBG (p < 0.01). AUC of normalized MTRasym (3.5 ppm) in identifying with/without DF in patients with DM is 0.986 (95% CI, 0.918-1.00) with the sensitivity of 97.22% and the specificity of 100%. Normalized MTRasym (3.5 ppm) and the BF in lesion may be treated as a safer and more convenient new indicator to evaluate the tissue infection without using a contrast agent, which may be useful in monitoring and preoperatively assessing DF patients with renal insufficiency.

The Relationship between Omentin Gene (ITLN1) Variant rs190234680 and Serum Omentin levels in patients with Diabetic Foot

Diabetic foot is a common and serious complication of diabetes, characterized by neuropathy, ischemia, and infections which can lead to amputation of the affected limb. Omentin is a protein that is predominantly expressed in adipose tissue and has been implicated in insulin sensitivity and glucose metabolism. Low plasma omentin levels have been associated with several metabolic disorders, including T2DM. Objectives: Study objective were to assess the pattern of omentin-1 [ITLN1] single nucleotide gene polymorphism in diabetic foot patients compared to uncomplicated T2DM. It also sought to compare the serum omentin-1 levels between diabetic foot patients and those with uncomplicated Type 2 diabetes mellitus and determine the association between omentin levels and the clinical staging of diabetic foot patients. Methodology: In this cross-sectional analytical study, 130 participants of DF and T2DM were enrolled. Omentin (ITLN1) gene polymorphism(rs190234680) was determined by sequencing and serum omentin levels were estimated by ELISA. Result: A significant association was observed between the GG genotype (wild type) of the omentin (ITLN1) gene and diabetic foot, while no significant difference was found in serum omentin levels between cases and controls. The analysis did not provide clear evidence of a significant relationship between omentin levels in different grades of diabetic foot Conclusion:The study suggested that the GG genotype of omentin 1 gene may be an important risk factor in development of diabetic foot in patients with type 2 diabetes. However, there was no significant difference in serum omentin levels between different stages of diabetic foot.

Effects of continuing nursing intervention on high‐risk patients with diabetic foot ulcers: A meta‐analysis

AbstractA comprehensive meta‐analysis was conducted to evaluate the impact of continuous nursing interventions on patients with high‐risk diabetic foot (DF). We systematically searched electronic databases including PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang for randomized controlled trials (RCTs), from database inception to October 2023, pertaining to continuous nursing interventions in high‐risk DF patients. Independent literature screening, data extraction and quality assessment were performed by two researchers. Data analysis was executed using Stata 17.0 software. Overall, 18 RCTs involving 1450 high‐risk DF patients were included. The analysis revealed that continuous nursing interventions significantly reduced levels of fasting blood glucose (standardized mean difference [SMD] = −1.02, 95% confidence interval [CI]: −1.29 to −0.76, p &lt; 0.001), 2‐h postprandial blood glucose (SMD = −1.76, 95%CI: −2.23 to −1.29, p &lt; 0.001) and glycated haemoglobin levels (SMD = −1.05, 95%CI: −1.40 to −0.70, p &lt; 0.001) in high‐risk DF patients. Furthermore, there was a significant reduction in the incidence of DF (odds ratio [OR] = 0.22, 95%CI: 0.14–0.33, p &lt; 0.001). This study demonstrates that continuous nursing interventions are effective in controlling glycaemic indices (fasting blood glucose, 2‐h postprandial blood glucose and glycated haemoglobin) and reducing the incidence of DF in high‐risk patients. These interventions contribute to stabilizing the patients' condition and optimizing their prognosis.

TRADITIONAL AND NOVEL 3D MEASUREMENTS USING CONE-BEAM CT IN WEIGHT-BEARING CONDITIONS

3D accurate measurements of the skeletal structures of the foot, in physiological and impaired subjects, are now possible using Cone-Beam CT (CBCT) under real-world loading conditions. In detail, this feature allows a more realistic representation of the relative bone-bone interactions of the foot as they occur under patient-specific body weight conditions. In this context, varus/valgus of the hindfoot under altered conditions or the thinning of plantar tissues that occurs with advancing age are among the most complex and interesting to represent, and numerous measurement proposals have been proposed. This study aims to analyze and compare these measurements from CBCT in weight-bearing scans in a clinical population. Sixteen feet of diabetic patients and ten feet with severe adult flatfoot acquired before/after corrective surgery underwent CBCT scans (Carestream, USA) while standing on the leg of interest. Corresponding 3D shapes of each bone of the shank and hindfoot were reconstructed (Materialise, Belgium). Six different techniques found in the literature were used to calculate the varus/valgus deformity, i.e., the inclination of the hindfoot in the frontal plane of the shank, and the distance between the ground and the metatarsal heads was calculated along with different solutions for the identification of possible calcifications. Starting with an accurate 3D reconstruction of the skeletal structures of the foot, a wide range of measurements representing the same angle of hindfoot alignment were found, some of them very different from each other. Interesting correlations were found between metatarsal height and subject age, significant in diabetic feet for the fourth and fifth metatarsal bones. Finally, CBCT allows 3D assessment of foot deformities under loaded conditions. The observed traditional measurement differences and new measurement solutions suggest that clinicians should consider carefully the anatomical and functional concepts underlying measurement techniques when drawing clinical and surgical conclusions.

Dellon Triple Decompression under WALANT

The Wide-Awake Local Anesthesia No Tourniquet (WALANT) Approach to Dellon Triple decompression involves the use of local anesthetic with epinephrine and no tourniquet. This study shows that WALANT is a safe and effective procedure and can be performed in an outpatient setting for the decompression of the common peroneal nerve in the knee, tibial nerve in the ankle and deep peroneal nerve in the dorsum of the foot in diabetic patients with superimposed nerve compressions to diabetic neuropathy. WALANT technique demonstrated to be a safe procedure to surgically treat diabetic patients with superimposed compressive neuropathy to diabetic neuropathy in the lower limbs and had no complications.

RESEARCH OF MATERIALS AND DESIGN OF ORTHOPEDIC INSOLE

The article is done to study the influence of orthopedic products based on composite materials on the comfort of shoes for diabetic patients. The purpose of the work is to identify certain preventive and therapeutic effects of orthopedic products for people with diabetes. The study focuses on various composite materials, predominantly silicone-based, the feet of diabetic patients, and the design of orthopedic products. To develop specialized insoles were utilized data derived from anthropometric investigations conducted on the feet of diabetic patients. Statistical parameters characterizing the feet were meticulously determined and subsequently employed in the design of insoles tailored for diabetic footwear. A comprehensive methodology was employed in the development of these specialized insoles, integrating a mathematical model and a computer program to simulate the insole, alongside an image analysis program that facilitated the extraction of anthropometric data. The resulting design of the insole for comfortable diabetic shoes encompasses three distinct layers: an upper layer, a lower layer, and an intermediate layer. The use of orthopedic insoles made of silicone composites allowed to reduce the pressure on the painful areas of the foot. The outcome of this study is the development of orthopedic products that not only contribute to the treatment and rehabilitation of diabetic patients but also enhance their overall quality of life. Furthermore, this research underscores the potential to elevate the level of social security for these individuals. As such, the significance of this study lies in its ability to address a pressing healthcare issue, ultimately improving the well-being of diabetic patients.

Stem Cell Therapy for Diabetic Foot: An Umbrella Review of Systematic Reviews and Meta-Analyses.

Objective: This umbrella review aims to summarize and evaluate the evidence from current systematic reviews/meta-analyses (SRs/MAs) on the effectiveness of stem cell therapy for diabetic foot (DF). Approach: We conducted a comprehensive search in four databases for SRs/MAs that included randomized controlled trials (RCTs) on stem cell therapy for DF. Two separate researchers independently evaluated the methodological quality and evidence quality of the SRs/MAs that were included in the study. We conducted a quantitative synthesis of all RCTs included in the SRs/MAs to obtain objective and updated conclusions. Egger's test and sensitivity analysis are used to examine the reliability of the results. Results: This umbrella review includes eight SRs/MAs, and their methodological quality and evidence quality were all deemed unsatisfactory. Out of the 8 SRs/MAs, 26 RCTs were included, with a total corrected covered area of 21.4%, indicating a high degree of overlap. The test of super-significance did not yield any significant results. Our updated meta-analysis suggests that DF patients can benefit from stem cell therapy, as indicated by effectiveness in measures, including healing rate, amputation rate, ankle-brachial index, transcutaneous oxygen pressure, ulcer size reduction, complete healing time, pain-free walking distance, rest pain score, and new angiogenesis rate. Innovation: This study conducted a comprehensive evaluation and reanalysis of the current evidence regarding the effectiveness and safety of stem cell therapy for DF, which is the first of its kind. Conclusion: Based on the existing evidence, stem cell therapy is effective and safe for patients with DF.

Therapeutic Adherence and Podiatric Care Related to the Development of Diabetic Foot in Patients Enrolled in the Chronic Disease Care Program, Perla Maria Norori Health Center, León, III Quarter, 2023

Therapeutic Adherence and Podiatric Care Related to the Development of Diabetic Foot in Patients Enrolled in the Chronic Disease Care Program, Perla Maria Norori Health Center, León, III Quarter, 2023

FRI606 Changes In The Pedal Microcirculation Of Diabetic Patients With Poor Glycemic Control Detected Using Non Invasive Optical Imaging

Abstract Disclosure: I.K. Bolakale-Rufai: None. S. French: None. J.C. Arias: None. K. Concha-Moore: None. T. Tan: None. D.G. Armstrong: None. A. Mazhar: Employee; Self; Modulim. C.C. Weinkauf: None. Background: Microvascular disease (MVD) describes systemic changes in the small vessels (∼100 υm diameter) that impair tissue oxygenation and perfusion. Emerging evidence has shown that MVD (which is prevalent in diabetics) is clinically relevant as it synergistically acts with peripheral arterial disease to increase the risk of limb loss by 22.7-fold. Poor glycemic control has been linked to clinical microvascular disease (nephropathy and retinopathy) However, the direct impact of poor glycemic control on the microcirculation of the feet is unknown as there are currently no standardized non-invasive methods used clinically to assess and quantify MVD of the lower limbs. Spatial frequency domain imaging (SFDI) is a novel non-invasive optical technology that can detect and quantify microvascular disease of the foot by measuring the amount of hemoglobin(HbT1) in the capillaries of the superficial dermis up to 1-2mm deep and oxygenation (StO2) in the dermal micro-circulation. We hypothesize that poor glycemic control in DM affects pedal microcirculation and the changes can be detected using the SFDI technology. Methods: 307 patients (600 lower extremity limbs) were prospectively enrolled at a single institution, Banner University Medicine, Tucson, AZ from 2016- 2023. Diabetic patients were stratified into three groups based on their HbA1c level: ≤6.7%, 6.8-9.9%, and ≥10%. Mann U Whitney test and Spearman rank correlation were used in testing the association between HbA1C and SFDI-metrics with p&amp;lt;.05 considered as statistical significance. Results: We included 230 lower limbs belonging to diabetic patients. The mean age of the patients was 61.7 years. Clinical neuropathy and retinopathy were found in 79% and 30.7% of patients, respectively. SFDI-derived biomarkers of microcirculation were compared among diabetics categorized by HbA1C levels. We observed a significant reduction in papillary dermal perfusion (HbT1) as the glycemic control (HbA1C) of the patients worsened (p&amp;lt;0.001). Although tissue oxygenation (StO2) was not statistically different across diabetic groups, the St02/HbT1 ratio which represents the ratio of tissue oxygenation to perfusion, increased with elevated HbA1C levels. This indicated that poorly controlled diabetics had less oxygen being extracted from their poorly perfused micro-circulation. Conclusions: This study suggests that poor glycemic control directly affects the microcirculation of the feet in diabetic patients. The SFDI technology is a promising noninvasive tool to evaluate microvascular disease of the feet and potentially may be utilized clinically to stratify diabetic patients at risk for foot ulceration or limb loss based on glycemic control over time. Presentation: Friday, June 16, 2023