Diabetic Foot Ulcer

Excerpt

Diabetes mellitus is a metabolic endocrine disorder due to an overall deficiency of insulin (Type 1) or defective insulin function (Type 2) which causes hyperglycemia. Type 1 diabetes which is usually seen in younger patients accounts for 5% to 10% of cases worldwide and is secondary to the autoimmune destruction of insulin-producing B-islet cells of the pancreas which results in complete insulin deficiency. Type 2 diabetes accounts for 90% to 95% of cases worldwide and is due to genetic and environmental factors with resultant insulin resistance and pancreatic beta-cell dysfunction causing relative insulin deficiency. This form of diabetes remains clinically inevident for many years. Although abnormal glucose metabolism which is associated with chronic hyperglycemia results in complications that can either be macrovascular or microvascular. The macrovascular disease affects mainly the cardiovascular and cerebrovascular systems, and the microvascular disease includes nephropathy, retinopathy, and neuropathies.

A debilitating complication of diabetes mellitus is diabetic ulcers, which leads to increased overall morbidity in patients. This complication may be prevented, as the inciting factor is most often minor trauma. Early identification of these cutaneous injuries also can lead to improved outcomes while decreasing the risk of progression. Patients with diabetes mellitus (type 1 or 2) have a total lifetime risk of a diabetic foot ulcer complication as high as 25%.