At the end of this chapter, the learner will be able to:
Discuss the trends in diabetes.
List the effects of diabetes on all wound etiologies.
Identify risk factors leading to diabetic foot ulcers.
Compare and contrast different interventions appropriate for treatment of diabetic foot ulcers.
Develop a comprehensive plan of care for a patient with a diabetic foot ulcer.
Select the proper footwear to both prevent and treat the diabetic foot.
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 diabetes 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.
However, it is the responsibility of the wound care clinician to (1) review the patient's blood glucose values to ensure there is adequate control of the disease to support effective wound healing and (2) recognize when the disease may be negatively affecting a patient's wound healing potential.
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.
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—2018.2 This chapter also provides an overview of treatment strategies necessary for patients to control their diabetes in order to assist in optimal treatment of chronic wounds, including diabetic foot ulcers.
Epidemiology and Health Care Implications
The prevalence of diabetes has been rising steadily and dramatically over the past several decades and is currently considered to be at epidemic proportions worldwide.1,3 In 2017 the global prevalence for diabetes is estimated to be 425 million individuals, projecting growth to 629 million in 2045.3 The Centers for Disease Control and Prevention (CDC) estimates that as of 2017 the United States had 30 million people diagnosed with diabetes, or roughly 9.4% of the population, plus another 7 million that are undiagnosed with type 2 diabetes (T2DM).4 In addition to ...