Diabetic Foot Disease and Oedema

Patients with diabetes are likely to be affected by Diabetic foot ulcers (DFUs). This type of disease is popular and enfeeble, generating a surge of serious morbidity and mortality combined with worldwide socio-economic problems.

The symptoms of this disease such as infection and inflammation raise surrounding oedema of the foot. Foot oedema can not be decreased by some regular offloading devices including total contact casts and removable cast walkers. However, there is scientific evidence to suggest that active oedema is reduced by intermittent pneumatic compression in the diabetic foot promotes ulcer healing. 

As a result of an experiment with 18 patients who have normal arterial circulation, people suffering from diabetes with lower limb oedema, mild compression therapy (18–25 mmHg) applied via socks or hosiery during the day was found to hinder the swelling by decreasing oedema, without any adverse impact on vascularity.

A randomized controlled study to evaluate the effect of pharmacist-led educational intervention on glycemic control, self-care activities and disease knowledge among type 2 diabetes patients: a consort compliant study protocol demonstrated in Pakistan. The pharmacist-led educational team to show that a healthy diet, regular exercise, self-monitoring of blood glucose, and self-care activities demonstrated a decrease in incidences of complications in patients. It was a 6-month educational intervention that examined patients glycemic control, self-care activities with people that have type 2 diabetes. The subjects previously didn’t have much control of their type 2 diabetes but after the intervention had an astounding impact on their daily living. The primary outcome was the change in patient A1C and the changed in self-care was secondary. The study helped patients that have a higher risk of late complications with diabetes and have better glycemic goals.

One important factor within diabetic foot infections is the classification of the severity of the disease. The treatment plan is tailored to the severity of the diabetic foot infection. The widely used Wagner classification is used to assess the ulcer depth and pressure and if there is any presence of osteomyelitis or gangrene. The complexity of diabetic foot infection is self-care and the patient ongoing care is the important factor in triumph over the patient’s foot. 

The application of intermittent pneumatic compression by the A-V Impulse System has been demonstrated. The function of intermittent pneumatic compression by the A-V Impulse System has been tested to be safe and productive among clinical areas. Particularly, the imitation of the natural physiological processes that keep blood flowing is developed by the A-V Impulse System significantly promoting venous return and arterial blood flow in the extremities.

In the treatment of DFUs, researchers have applied compression therapy productively and carefully to dwindle oedema in a patient with diabetes with sufficient arterial circulation while lower compression was helpful in patients with arterial compromise in a prospective clinical case review consisting of 44 patients.

In addition, during 12 weeks follow-up, a double-blind randomized controlled trial also pointed out that oedema was reduced by a pneumatic foot compression system, which boosted the recovery rate of wound healing. Specifically, a functioning pulsatile pneumatic foot compression system achieved by way of a pump has been experimented on fifty-nine patients with diabetes.

Treatment of oedema might additionally enable positive reaction of DFUs, exceeding standard therapy. A comfortable device increases concordance, is available to supply intermittent pneumatic compression to actively minimize oedema, and allow offloading can be helpful to achieve this goal; however, to check the strong level of the effectiveness, further investigation will be required.

Due to the complexity of pathogenesis of DFUs together with several related issues, none of the many grading systems takes into account any associated oedema of the foot, emphasizing that people still have inadequate knowledge regarding many aspects of DFUs. It will be interesting to figure out the connection between diabetic symptoms and foot ulcers to have the best treatment for patients with diabetes.

Practice Pearls:

• Diabetic foot ulcers (DFUs) which are highly associated with diabetes lead to dangerous complications.
• DFUs are proved to be treated by appliances that reduce the detrimental effect of oedema.
• This study was done on some people suffering from diabetes and DFUs but still need more experiments to confirm the effectiveness of the treatment.

1. Bukhsh, & M. Nawaz. A randomized controlled study to evaluate the effect of pharmacist-led educational intervention on glycemic control, self care activities and disease knowledge among type 2 diabetes patients. Medicine March 2018
2. Ho, R. Leigh. Diabetic foot disease and oedema. The British Journal of Diabetes & Vascular Disease March 5, 2013

Idris Aderoju, Pharm.D. Candidate, Florida A&M University