Prevent and treat diabetic foot, do not re -treat light prevention
Guide
Recently, China Diabetes Magazine publishes the relevant content of the “China Diabetes Foot Prevention Guide (2019 Edition)”. This is also the latest prevention guide for diabetes. Professor Ran Xingwu, the leader of the feet and surrounding vascular lesions, pointed out that at present, my country has made great progress in the diagnosis and treatment technology of diabetic foot, which has reduced the amputation rate of diabetic foot from 12.1%to 2.14%. However, our diabetes The more patients with foot disease have become more and more. The reason is that the reason is neglected. Therefore, Professor Ran Xingwu emphasized that in the promotion and application of the guide, he should adhere to the concept of “prevention greater than governance” in diabetes.
There are one amputation of diabetic patients every 20 seconds in the world
Foot ulcer is the most common manifestation of diabetic foot disease, and it is also the main cause of amputation of patients with diabetes. The prevalence of global diabetic foot ulcers is 6.3%, men are higher than women, and type 2 diabetes higher than type 1 diabetes. It is estimated that there is an amputation of diabetic patients every 20 seconds. The prevalence of the prevalence of diabetic foot ulcer between countries and different regions is extremely large, with 1.5%-16.6%. In my country, the annual incidence of diabetic foot ulcers is 8.1%, the annual recurrence rate is 31.6%, and the annual mortality rate is 14.4%. 45%of the patients are level 3 or above (medium to severe lesions), with a total amputation rate of 19.03%, of which large amputation is 2.14%and small amputated 16.88%. Because of the limited data of diabetic foot disease, the incidence, prevalence and amputation rate of diabetic foot disease often underestimate the incidence of diabetic foot disease.
Specific processes and frequency of diabetic foot screening
Diabetic foot disease is very poor, sugar-footed infection and other related medical expenditures are quite expensive. In developed countries, diabetic sufficient accounted for 12%-15%of diabetic medical and health resources. In developing countries, this number is as high as 40%, so Pay attention to early screening of diabetic feet. Early screening and correction of risk factors related to diabetic foot disease can avoid and slow the occurrence of diabetic feet to the greatest extent, which not only greatly reduces the medical burden of medical care, but also reduces the psychological and physiological damage caused by amputation such as amputation.
One of the highlights of this new version of the guidelines is to refer to the Chinese clinical research data. For the main causes of diabetic peripheral neuropathy and the lower limb pathogenesis of diabetes for the main causes of diabetic feet, specific screening processes and frequencies make the guide more practical application value. In addition, the guide combines my country’s national conditions, which focuses on improving the status of diabetes and foot prevention. It is still a comprehensive prevention concept from overall to local. The campaign gives guidance, and has put forward new requirements for daily inspections of foot, 胼胝 prevention, and early diagnosis of feet mechanics changes.
The process of screening of diabetic peripheral neuropathy is shown in Figure 1. Only 10%-20%of the patients with lower limb vascular lesions (Lead) have intermittent lame symptoms. Therefore, if only the patient’s symptoms determine whether the lower limb vascular lesions will cause missed diagnosis. The screening process of the lower limb vascular lesions of diabetes is shown in Figure 2. Among them, ABI checks low, simple, and repetitive, so it is often used as a PAD screening tool.
Diagnosis and treatment
In the past, the diagnosis of vascular lesions of the lower limb was proposed by the Society of Vaste Surgery. It did not have the characteristics of patients with diabetes. This guide has accumulated evidence of evidence -based medical evidence in recent years. The clinical manifestations of lower limb arteries stenosis or occlusion; (3) If the patient’s calm ankle liberty index (ABI) ≤0.90, regardless of the patient’s symptoms of lower limb discomfort, the lead should be diagnosed; Patients with ≥0.90, such as ABI decreased by 15%-20%after the trial test of the bicycle tablet test, indicates that the blood vessels are narrow, and the Lead should be diagnosed; The lower limb arteries have narrow or occluded lesions of the lower limb arteries; (6) If the patient static ABI <0.40 or the ankle artery pressure <50mmHg or toe artery pressure <30mmHg, severe limb ischemia should be diagnosed. For patients with Lead, they need to relieve symptoms, delay their progress, while reconstruction of blood transportation, and reduce the occurrence of amputation and cardiovascular events.
<!-2586: Diabetic terminal page
In addition, patients with diabetes also have chronic venous lesions (CVDs) in the lower limbs. Doppler ultrasound is the gold standard of CVD by non -invasive intravenous testing method; compression treatment is the basis for treating CVD; Schotott, Hittin drugs, calcium hydroxylsulfate, psychic, prostaglandin analogs, hexone cocoa, and cytokines. If the effect is not good, the deep vein can be evaluated treat.
Diabetes peripheral neuropathy contaidies to include metabolic control, antioxidant stress, improvement of microcirculation, inhibitory aldoscope restoration enzymes and nerve repair, etc.; The guide also gives treatment strategies for the autonomous neuropathy of each organ.
