November is Diabetes Awareness Month, and as an internist and a wound care specialist, much of my day-to-day routine is treating people with diabetes. Many people are aware of what diabetes is and are affected by it, but most do not know about the major complications associated with it or what to do about them.
In this blog, I’ll address one of those major complications: diabetic foot ulcers (DFU). Most people are unaware of how dangerous a DFU can be and what other complications it can lead to. I am hoping to bring awareness to this issue.
There are approximately 32 million people in the US that have been diagnosed with diabetes and it has been theorized that 72 million people in the U.S. are unaware that they have diabetes. Ten percent of these individuals will have a DFU in their lifetime. Of those, 15% will not be able to heal and 25% of those will require a limb amputation. In fact, DFUs account for 85% of non-traumatic amputations. Fifty percent of people with diabetes who undergo an amputation of the lower limb will die within two years.
The good news is that DFUs are preventable!
DFUs have risk factors associated with them like any other medical condition, and these can be fixed or improved. In fact, studies show that DFUs can be decreased by 50% just by appropriate patient education.
The best way to treat a DFU is to prevent one from developing. Below is a list of the most common risk factors for DFUs. The more risk factors you have increases your chances of getting one. In most cases, these risk factors can be improved or completely corrected.
- Poor fitting shoes
- Improper nail care
- Poor hygiene
- Foot deformities (bunions, hammertoes, calluses, etc.)
- Alcohol abuse
- Heart disease and vascular disease
- Kidney disease
- Eye disease
The cause of the actual ulcer formation is typically a combination of a perfect storm: decreased feeling in the feet (neuropathy), decreased circulation, foot deformity, with irritation (friction) or trauma to open up the skin.
To decrease your chances forming a DFU, you should seek out a primary care provider to help manage your diabetes. The sooner you do this the better, as prolonged high sugars lead to neuropathy and vascular disease (poor blood flow). Your primary care provider can prescribe appropriate medications and refer you to a diabetes educator to discuss diet plans tailored to you. Diabetes control is measured by a figure called the HgA1c, which is a marker of sugar control over the prior 90-120 days. Getting to know this number, as well as your fasting and non-fasting sugars, will empower you and help you to control your diabetes. Your doctor also can do regular foot checks, test for neuropathy, check your blood flow and address any of the other risk factors during your visits.
Should you develop a DFU, the UT Health East Texas Wound Healing Center in Tyler offers a multidisciplinary approach to healing the current wound and the prevention of future wounds. We use proven treatments that include but are not limited to:
- Debridement of the wound
- Treating infection
- Decreasing friction and pressure
- Restoring adequate blood flow
- Dressings and other modalities
- Nutritional support
If there is a comprehensive team approach to wound care, the risk for amputation decreases by 75%
In closing, visit your primary care physician regularly to keep your diabetes under control. If you do get a wound, act fast. Ask your doctor to refer you to the UT Health East Texas Wound Healing Center or call 903-526-4325.