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CHAPTER OBJECTIVES

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At the end of this chapter, the learner will be able to:

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  1. Discuss the trends in diabetes.

  2. List the effects of diabetes on all wound etiologies.

  3. Identify risk factors leading to diabetic foot ulcers.

  4. Compare and contrast different interventions appropriate for treatment of diabetic foot ulcers.

  5. Develop a comprehensive plan of care for a patient with a diabetic foot ulcer.

  6. Select the proper footwear to both prevent and treat the diabetic foot.

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INTRODUCTION

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The classic model of the neuropathic foot is most frequently associated with diabetes. Diabetes is a commonly encountered comorbidity in the population of patients with wounds. While many comorbidities have the potential to impact wound healing, this is especially true with diabetes. Therefore, the health care professional needs to understand the diabetic disease process, its implications on the general health of the patient, and its impact on wound healing specifically. The wound care clinician does not manage the diabetes—this responsibility belongs to another provider, usually a primary care physician or an endocrinologist who coordinates the overall diabetes plan of care.

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However, it is the responsibility of the wound care clinician to review the patient’s blood glucose values to ensure there is adequate control of the disease in order to support effective wound healing and to recognize when the disease may be affecting a patient’s wound healing potential.

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CLINICAL CONSIDERATION

The disease state of diabetes is managed by a team of specialists. In the absence of a team, the primary care physician or endocrinologist will direct the medical management of this complicated disease.

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This chapter provides an overview of the epidemiology of diabetes, its effects on wound healing, clinical challenges that the comorbidity of diabetes poses to the form and function of the foot, and considerations for clinical interventions when a diabetic foot ulcer (DFU) is present. For comprehensive information on the pathophysiology and treatment of diabetes, the reader should consult other sources, including the standards of care from the American Diabetes Association1 and American Association of Clinical Endocrinologists’ comprehensive diabetes management algorithm—2013.2 This chapter also provides an overview of treatment strategies necessary for a patient to control diabetes to assist in optimal treatment of chronic wounds, including diabetic foot ulcers.

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DIABETES

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Epidemiology and Health Care Implications

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The prevalence of diabetes has been rising steadily over the past several decades, and is currently considered to be at epidemic proportions worldwide.1,3,4 It is projected that there will be 552 million people with diabetes worldwide by 2030. The Centers for Disease Control estimates that as of 2011 the United States had 27 million individuals diagnosed with diabetes, or roughly 7% of population and an additional 7 million that are undiagnosed with Type 2 diabetes (T2DM).5 This number continues to increase despite significant efforts ...

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