The study highlights the need to reduce the risk of diabetic foot ulcers and to improve fall risk screening, assessment and interventions in patients with DFU. “Important steps to reducing the risk of DFU are ensuring patients are screened to identify risk factors, educated regarding self-care, and promptly treated by specialists with appropriate resources such as evidence-based advanced wound care therapies to enhance wound healing and prevent amputation,” Allen told U.S. Medicine.
According to the American Podiatric Medical Association, Native Americans, African-Americans, Hispanics and older men with diabetes have a higher risk of developing foot ulcers. Neuropathy, poor circulation, foot deformities such as bunions or hammer toes, and habitually wearing ill-fitting shoes make foot ulcers more likely. Other risk factors include insulin use, smoking, alcohol consumption, hypercholesterolemia and uncontrolled glycemic levels.
Meanwhile, a group of VA researchers is trying to minimize the recurrence of diabetic foot ulcers. The VA Rehabilitation Research and Development Service awarded $1.1 million to the VA New York Harbor Healthcare System to prevent DFU.
The program, “STEP UP to Avert Amputation in Diabetes,” educates diabetic patients who have previously had a DFU about the risks associated with foot ulcers and trains them in self-care, including regularly checking their feet and wearing appropriate shoes. It also shows them how to monitor the temperature of the soles of their feet with a special thermometer. Inflammation leads to elevated readings, which may indicate that an ulcer is about to form.
Patients in the program who detect a higher than normal reading on just one foot are encouraged to rest and elevate the “hot” foot for 24 hours. If the temperature remains high, the patient follows up with a foot specialist, who will often recommend cushions or special shoes that protect the at-risk region of the foot.
Preventing recurrent foot ulcers will reduce the risk of amputation. More than 80% of the non-traumatic amputations in the VA are caused by complications of DFU, according to lead researcher Sundar Natarajan, MD, MSc. He said he hopes that the STEP UP program will “lead to a new strategy to prevent the devastating complications of foot ulcers.”
- Rice JB, Desai U, Cummings AK, Birnbaum HG, Skornicki M, Parsons NB. Burden of diabetic foot ulcers for Medicare and private insurers. Diabetes Care. 2014;37(3):651-8. doi: 10.2337/dc13-2176. Epub 2013 Nov 1. Erratum in: Diabetes Care. 2014 Sep;37(9):2660.
- Allen L, Powell-Cope G, Mbah A, Bulat T, Njoh E. A Retrospective Review of Adverse Events Related to Diabetic Foot Ulcers. Ostomy Wound Manage. 2017 Jun;63(6):30-33.
About 5% of the United States population has been diagnosed with type 1 diabetes, and the great majority are diagnosed before age 25. Since a diabetes diagnosis prevents enlistment in the military, relatively few veterans have the condition compared to type 2 diabetes, which affects about a fourth of VHA patients.
OAKLAND, CA—Data from more than 1.3 million VHA patients was used to help validate a practical tool for identifying people with diabetes who are at the highest risk for being admitted to an emergency department... View Article