Отчеты о случаях диабета

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Prevention of Diabetic Foot Ulcers and Amputations

Mark Hinkes

Diabetic foot ulcer is a significant complexity of diabetes mellitus, and presumably the significant segment of the diabetic foot. Wound recuperating is an intrinsic system of activity that works dependably more often than not. A key element of wound recuperating is stepwise fix of lost extracellular grid (ECM) that frames the biggest part of the dermal skin layer. Be that as it may, at times, certain scatters or physiological affront upsets the injury recuperating process. Diabetes mellitus is one such metabolic issue that blocks the typical strides of the injury mending process. Numerous investigations show a drawn out provocative stage in diabetic injuries, which causes a postponement in the development of develop granulation tissue and an equal decrease in wound rigidity.  Treatment of diabetic foot ulcers ought to include: glucose control, expulsion of dead tissue from the injury, wound dressings, and expelling pressure from the injury through methods, for example, all out contact throwing. Medical procedure sometimes may improve results. Hyperbaric oxygen treatment may likewise help however is costly.  It happens in 15% of individuals with diabetes, and goes before 84% of all diabetes-related lower-leg removals. Amputation is the removal of a limb by trauma, clinical disease, or medical procedure. As a careful measure, it is utilized to control torment or an infection procedure in the influenced appendage, for example, danger or gangrene. Now and again, it is done on people as a preventive medical procedure for such issues. An exceptional case is that of inherent removal, an inborn issue, where fetal appendages have been cut off by constrictive groups. In certain nations, removal of the hands, feet or other body parts is or was utilized as a type of discipline for individuals who carried out violations. Removal has additionally been utilized as a strategy in war and demonstrations of psychological oppression; it might likewise happen as a war injury. In certain societies and religions, minor removals or mutilations are viewed as a custom achievement.  At the point when done by an individual, the individual executing the removal is an amputator. The cut away individual is called an amputee. In the US, most of new removals happen because of confusions of the vascular framework (the veins), particularly from diabetes. Somewhere in the range of 1988 and 1996, there were a normal of 133,735 clinic releases for removal every year in the US. In 2005, just in the US, there were 1.6 million amputees. In 2013, the US has 2.1 million amputees. Roughly 185,000 removals happen in the United States every year. In 2009, medical clinic costs related with removal totaled more than $8.3 billion. There will be an expected 3.6 million individuals in the US living with appendage misfortune by 2050. African Americans are up to multiple times bound to have a removal than European Americans.

Problem Statement: With nearly 500,000 patients diagnosed with diabetes and 500,000 people diagnosed with prediabetes there are now 1 billion people worldwide who are affected with the condition. Statistics reveal that a large percent of this population has some form of neuropathy that is a contributing factor for developing foot ulcers that lead to infection, hospitalization and all too often amputation.

Approach: This presentation is designed to educate medical providers on the issues of diabetic foot ulcer formation and amputation of the lower extremities resulting from diabetic neuropathy and suggests opportunities for prevention.

Results: The presentation will explain the mechanisms of action that results in diabetic foot ulcers that can lead to amputations and explores opportunities for prevention by:

1.         Providing information on the statistics associated with diabetic neuropathy and lower extremity pathology.

2.         Recognizing the cost of treatments.

3.         Understanding the 3 subcategories of neuropathy and the effect on patients.

4.         Describing the mechanism of ulcer development via three type of triggering events.

Conclusions:

1.         The role of the PCP in prevention.

2.         Identify patient risks and prevention needs by focused history and physical exam.

3.         Identify issues that require referral to members of the multidisciplinary team.

4.         Patients as partners and patient education