risk factors of Diabetic Foot

Risk based ulcer prevention
Diabetic foot care pathway
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i t y3. W e need t o exam i ne epi dem i ol ogi cal and experi m evi dence of t he ef f ect s of envi ronm ent al chem i cal s, i nc t oxi c m et al s,persi st ent organi c pol l ut ant s (PO Ps) and bi sp A (BPA ;Fi gure 1). For i nst ance, t here i s m uch evi dence f or a rel at i o bet w een heavy m et al s and t he ri sk of obesi t y and di A rseni c i s rel at ed t o cancer and peri pheral vascul ar di
High Risk Pathologies – Deformity
leads to pre-ulcer lesions
High risk Pathologies - Nails
Pathogenesis and potential relative risk factors of diabetic neuropathic osteoarthropathy
Risk factors of Diabetic Mellitus and Diabetic Foot
Zhijie Xi, MD
m ai n pat hogenesi s oft ype 2 di abet es i nvol ves b-cel ldysf unct i on i n t he pancreas and peri pheral i nsul i n resi st ance. Fact ors cont ri but i ng t ot he devel opm ent of t ype 2 di abet es i ncl ude ol d age, obesi t y, l ack of physi cal act i vi t y, a f am i l y hi st ory of di abet es and a genet i c predi sposi t i on. H ow ever, t hese t radi t i onal ri sk f act ors al one cannot expl ai n t he rapi dl y i ncreasi ng preval ence of di abet es w orl dw i de (Fi gure 1).
Risk factors for neuropathic pain in diabetes mellitus
Schematic of the process from diabetes mellitus to diabetic neuropathy and finally painful diabetic neuropathy. Both diabetes mellitus and diabetic neuropathy have their own set of risk factors, both of which could provide important clues as to the risk factors that contribute to painful diabetic neuropathy
• • • • • • • • Age Gender Weight duration and type of diabetes bone mineral density peripheral neuropathy and arterial disease trauma history and some others
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Ri sk f actor sf ordi abetes
Risk factors diabetes. Environmental the air, water and soil that are chronically exposed to people. Fi gure 1 |Ri sk for f act or sf or di abet es.Envi r onmchemicals ent alchemhave i cal s contaminated have cont am i nat ed t he ai r ,w at er and soi lt hat ar e chr oni cal l y exposed t o peop These are considered to be the new risk factors for diabetes, and affect the pathogenesis of diabetes with traditional risk factors. As, c; These ar e consi der ed t o be t he new r i sk f act or sf or di abet es,and af f ect t he pat hogenesi s ofdi abet es w i t ht r adi t i onalr i sk f act or s.As,ar seni bi sphenolA;Cd,cadm i um ;Hg,m cur y;PO Ps,per si st ent or gani c pol l ut ant s. organic pollutants. arsenic; BPA, bisphenol A; Cd,er cadmium; Hg, mercury; POPs, persistent
Risk factors of diabetes
• • • • Being overweight Being 45 years or older Having a family story of II type diabetes Ever having gestational diabetes or giving birth to a baby who weighted more than 9 pounds
Diabetic foot lesions frequently result when 2 or more are present
Diabetes Stratification
• Low Risk Foot (no referral needed)
– Good blood flow and protective sensation is intact
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o n al ti Trad i
Battery As Cd H g
sto ry y hi l Fam i on ti sp o si ed i c pr G en eti
ty O b esi
PO Ps des ci pesti W ater BPA ate Ph th al
se ci Lack o fexer
Other potential relative risk factors
• increased levels of HbA1c in serum • treatment with insulin/insulin and oral hypoglycemic agents • retinopathy • prolonged walking • living alone • and low literate education
• Moderate Risk Foot
Podiatry)
(referral to Primpheral Vascular Disease (PVD) and/or Peripheral Neuropathy with no other pathology
• High Risk Foot
Risk factors of diabetes
Risk factors of diabetic foot
• • • • • • • • • • • Male sex Smoking Hypertension Hyperlipidaemia DM > 10 years duration Peripheral neuropathy Abnormal foot structure Peripheral arterial disease Insulin resistance with compensatory hyperinsulinaemia H/O previous ulceration / amputation Poor glycemic control (HbA1c > 7%)
– with ‘high risk’ pathology
• Active Foot Disease
– Current ulceration or charcot neuro-athropathy
High Risk Pathologies – Callus & Corns
Pre- ulcer lesions