Lege Artis Medicinae

[The diabetic foot syndrome: pathomechanism, clinical picture, current treatment and prevention]

JERMENDY György

APRIL 20, 2012

Lege Artis Medicinae - 2012;22(04)

[Diabetic foot syndrome is a characteristic late complication of diabetes mellitus. It can develop in patients with type 1 as well as type 2 diabetes mellitus, especially in case of a long duration of diabetes and sustained poor metabolic state. Diabetic neuropathy plays a pivotal role in the pathomechanism, but vascular symptoms might also contribute to the complex clinical picture. For making the diagnosis, evaluation of complaints, performing physical examination and using simple tests for identifying both distal, somatosensory neuropathy and potential angiopathy are of great importance. Therapeutic approaches aim to achieve proper glycaemic control, as well as to ameliorate symptoms of neuropathy, improve peripheral blood supply by medicines, angioplasty or intervention radiological methods, fight against infections and off-load the foot. Surgical intervention might also be necessary, and in severe cases, amputation might be needed. The diabetic foot syndrome increases mortality risk in patients with diabetes. Complaints related to diabetic foot syndrome are often resistant to treatment and tend to recur. Thus, prevention with long-term, good metabolic control and protection of the foot are of particular importance.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[Fulvestrant in late stage breast cancer]

BÍRÓ Mátyás, BÜDI László, AL-JAZAIRI Abdul Baki

Lege Artis Medicinae

[The Illness of Franz Kafka and his Perception of the World ]

GERLINGER Lilla

Lege Artis Medicinae

[Implantable loop recorder for prevention of rare syncope]

TOMCSÁNYI János

Lege Artis Medicinae

[Inhibitors of the renal sodium-glucose cotransporter: possible new drug in armamentarium of diabetologists]

BECHER Péter, PATAI Árpád, MÁJER Katalin

[An important aim of diabetologists is prescribing modern antidiabetic drugs with not only glucose lowering but also an insulin sensitivity increasing property with weight loss without hypoglycaemic episodes and with positive effects on the pancreatic β-cells. A selective inhibition of the renal sodium-glucose cotransporter 2 protein leads to glucosuria, reduces HbA1c and body weight without hypoglycaemias. This benefits can also moderate the cardiovascular risk in diabetic patients. At the moment this molecules are under examination in different phase clinical studies. It seems that the first drug from this group for the clinical use will be the molecule dapagliflozin. The main side effect may be a vulvovaginal mycotic infection.]

Lege Artis Medicinae

[Treatment of hepatocellular carcinoma by liver transplantation: results in Hungary]

GÖRÖG Dénes, VÉGSŐ Gyula, DOROS Attila, GERLEI Zsuzsa, FEHÉRVÁRI Imre, NEMES Balázs, KÓBORI László

[INTRODUCTION - Hepatocellular carcinoma is an internationally accepted indication for liver transplantation in selected cases. The aim of this study was to present treatment results of patients diagnosed with hepatocellular carcinoma and put on the waiting list between 1995 and 2010. PATIENTS AND METHODS - Sixty patients were put on the waiting list, 23 of who died or became unfit for operation while waiting for transplantation. Liver transplantation was performed in 37 patients. Pathological examination revealed no tumour in 3 of the explanted livers, whereas incidentalomas were detected in 4 livers that were explanted because of cirrhosis. Thus, in total 38 patients were examined. RESULTS - Four patients died within 3 months of surgery because of arterial circulatory problems or graft dysfunction and 14 patients died thereafter, including seven whose tumour recurred. There was no recurrence of tumours in the early state among the 25 patients meeting the Milan criteria, and the overall 1-, 3-, and 5-year survival rates with an average follow-up period of 39 months were similar to those after transplantation because of viral cirrhosis: 72%, 72% and 67% vs. 78%, 71% and 67%, respectively. Survival rates after tumours beyond the Milan criteria were significantly lower (69%, 38%, 23%). CONCLUSION - Early-state (T1,T2) hepatocellular carcinoma that has developed following cirrhosis and is unsuitable for resection can be efficiently treated with liver transplantation, but our results do not support the use of transplantation for the treatment of tumours that do not fit the Milan criteria.]

All articles in the issue

Related contents

Hypertension and nephrology

[Summary of guidelines for American, European and International Companies in diabetes mellitus type 2 associated with hypertonia]

KÉKES Ede, DOLGOS Szilveszter

[The importance of hypertension in type 2 diabetes mellitus, the method of continuous blood pressure control and patient’s careas well as the forms of non-drug and drug therapy have been disclosed by presenting therapeutical recommendations from American, European scientific societies and international organizations. It has been established that the principles of care and treatment of hypertonia have basically remained unchanged in diabetes all over the world, despite the recent widespread debate over the interpretation of normal blood pressure and the consideration of the benefits of intensive or standard treatment.]

Lege Artis Medicinae

[Biosimilar insulins on the horizon]

JERMENDY György, KERPEL-FRONIUS Sándor

[Nowadays human insulins and insulin analogues are exclusively used in the clinical practice, when insulin therapy is needed. The patents of human insulins are expired and will expire soon for glargine, the first long-acting, basal insulin analogue preparation. The reliable production of biosimilar insulins is a new challenge for the pharmaceutical industry. Independently developed insulins with appreciable clinical efficacy have already become available in some countries where the quality criteria of regulatory process in place are less strict than in the European Union. The first approval for true biosimilar insulin, i.e. for biosimilar glargine was given in Europe in 2014. In this article, the characteristics of biosimilar insulins, especially the difficulties in the manufacturing process are reviewed in comparison with generic drugs. It is of note that potential efficacy and safety differences may occur due to even minor changes in the production, formulation and storage of the biological drugs. Therefore, biosimilarity should be investigated by detailed comparative pharmacokinetic and pharmacodynamic studies. Moreover, similar clinical efficacy and safety should be documented by randomized, comparative clinical trials. The potential impact of altered immunologic profile of biosimilar insulins should also be carefully monitored. ]

Lege Artis Medicinae

[Direct health care costs of diabetes mellitus in Hungary]

VOKÓ Zoltán, NAGYJÁNOSI László, KALÓ Zoltán

[INTRODUCTION - Diabetes mellitus is responsible for a huge burden of disease all over the world, including Hungary, as well. The object of our study was to estimate the direct health care costs of treating patients with diabetes, in order to characterize this aspect of the burden of disease, and to facilitate the use of this information in further analyses. METHODS - We used the data of the National Health Fund. Diabetic patients were defined as persons who filled in a prescription of oral antidiabetics (OAD) or insulin in the second half of 2007. We divided this study population into two groups depending on whether they were or were not hospitalised for major complications of diabetes in 2007-2008. The group that was not hospitalised was further divided into three subgroups according to the use of drugs (only OAD, only insulin, OAD and insulin). In all study groups, we estimated the mean, the standard deviation, and the median of health care costs for each cost item by age group in the whole study group and among those who actually used a particular service. Additionally, we took samples of patients who were hospitalised for specific complications, and estimated the health care costs for the first and for the second year after the occurrence of the complication. RESULTS - The mean health care cost of the 521,545 diabetic patients involved in the analysis was 335 thousand HUF. It was 633 thousand HUF for those who were hospitalised for complications, 242 thousand for OAD users without complications, and 449 thousand for insulin users without complications. 53% of the total cost covered drug treatment and 27% acute hospital treatment. 26% of the total drug cost was spent on OADs and on insulin. The acute hospital cost and the drug cost had multiplied within the first year of complication. The latter remained high or further increased in the second year. CONCLUSION - The healthcare cost of diabetes is already very high in Hungary, especially the care for its complications. Considering the burden of disease that manifests in premature mortality, reduction in quality of life, and high cost, and the epidemiological trends, diabetes mellitus should be a public health priority in Hungary.]

Lege Artis Medicinae

[A new approach to the treatment of diabetic retinopathy - PPAR-α agonist activity of fenofibrate]

CSÁSZÁR Albert

[Diabetic retinopathy (DR) is a leading cause of visual impairment worldwide. It affects nearly half of patients with diabetes and its severity increases with the progress of diabetes. Glycotoxicity, lipotoxicity and hypertension are the main risk factors for the development of DR. The control of glucose homeostasis and blood pressure are the main noninvasive approaches that might have a role in the treatment of this condition. On the basis of new studies, RAS inhibitors and fenofibrate are promising candidates that can be used to retard DR progression and/or induce its regression. Two large-scale studies (FIELD, ACCORD Eye) have demonstrated that fenofibrate therapy significantly reduces the need for laser treatment of DR. The efficiency of this therapy, which is independent of lipid changes, is primarily attributable to the PPAR-α agonist activity of fenofibrates. According to guidelines that discuss the new therapeutic approaches of DR, fibrate therapy is a promising new option for preventing the progression of DR.]

LAM Extra for General Practicioners

[THE DIABETIC FOOT SYNDROME: PATHOMECHANISM, CLINICAL PICTURE, CURRENT TREATMENT AND PREVENTION]

JERMENDY György

[Diabetic foot syndrome is a characteristic late complication of diabetes mellitus. It can develop in patients with type 1 as well as type 2 diabetes mellitus, especially in case of a long duration of diabetes and sustained poor metabolic state. Diabetic neuropathy plays a pivotal role in the pathomechanism, but vascular symptoms might also contribute to the complex clinical picture. For making the diagnosis, evaluation of complaints, performing physical examination and using simple tests for identifying both distal, somatosensory neuropathy and potential angiopathy are of great importance. Therapeutic approaches aim to achieve proper glycaemic control, as well as to ameliorate symptoms of neuropathy, improve peripheral blood supply by medicines, angioplasty or intervention radiological methods, fight against infections and off-load the foot. Surgical intervention might also be necessary, and in severe cases, amputation might be needed. The diabetic foot syndrome increases mortality risk in patients with diabetes. Complaints related to diabetic foot syndrome are often resistant to treatment and tend to recur. Thus, prevention with long-term, good metabolic control and protection of the foot are of particular importance.]