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The BBC are reporting: Clue to diabetes limb loss cause
Scientists say they have discovered what causes a condition which can lead to people with diabetes having to have lower limbs amputated.
A team from the University of Bristol identified changes in skin tissue which precede the development of leg ulcers.
Sometimes, ulcers will not heal and the only solution is to amputate, usually below the knee.
Diabetes experts said lowering blood pressure, cholesterol and glucose cut complications from the condition.
It is estimated that around 50,000 people with diabetes will have a foot ulcer at any one time, and up to 15% of all foot ulcers will result in amputations.
People with Type 2, or adult onset, diabetes are particularly at risk.
The condition often goes undetected, meaning high blood glucose levels, high blood pressure, lack of fitness and weight problems are not addressed, potentially causing damage to the circulatory system.
One circulatory disorder is peripheral vascular disease, which particularly affects people with Type 2 diabetes.
Their treatment can cost the NHS as much as £600m a year.
The researchers looked at 14 patients who had needed below-the-knee amputations.
They compared skin tissue from their amputated leg with some from their healthy leg.
It was found that damaging changes were occurring in the connective tissue that supports the skin.
The rate of tissue renewal was much quicker than normal and poor blood supply leads to abnormal collagen - the protein that is the main support in connective tissue.
This means the skin is not as strong as it should be and can break down more easily, allowing ulcers to form.
Understanding what happens in the tissue could allow doctors to develop treatments which prevent ulcers developing and therefore help patients avoid amputations.
'Prevention not alleviation'
Dr John Tarlton, who found the link in his research at Southmead Hospital in Bristol, said: "The results of our study have opened up new avenues that previously no-one knew existed and the ramifications are far reaching in terms of finding clinical treatments to save people's limbs."
He added: "We believe that the principles of this research may be applied to other disorders where the tissues are affected by oxygen deficiency, such as ischaemic heart disease.
"More investigations are needed to understand how widespread this problem is, but hopefully this breakthrough will mean that we can start looking to ways to improve the quality of a great many people's lives."
Andy Proctor, of Action Medical Research, said: "Understanding the mechanism behind the ulcers means that, finally, clinical care may be directed at the causes rather than the alleviation of the symptoms."
Amanda Eden, of the charity Diabetes UK, said: "This research is very promising and we will watch with interest for further work in this area.
"To help avoid complications of diabetes such as these, we would advise people to reduce blood pressure and cholesterol levels and aim to have good control of blood glucose levels."
The scientific break through is more a psychological one - called compliance. Primary causes of ulceration include wearing no shoes, wearing horrible shoes, getting an infection and not checking your feet until they blow up like red party balloons, uncontrolled sugars and PVD as a complication of not controlling sugars.
Granted there are some people who do all the right things but they are a minority and damned unlucky.
The scientific break through is more a psychological one - called compliance.
Thats a term I have not heard in a very long time in the diabetes context. Do you realise how dated and politically incorrect that term is?
This is what I wrote in 2000 and referenced stuff going way back before that:
Adherence and self management
It could be assumed that of all the diabetes related complications, adequate self care of the foot and adherence to foot self management guidelines by those with diabetes has the greatest potential to have an impact on the disease process. Of most concern to the aetiology and management of diabetic foot disease is the well documented poor use of self-care behaviours in those with diabetic foot complications (Plummer & Albert, 1995; Sriussadaporn et al, 1998). However, these studies on the lack of adherence to foot self care guidelines need to be interpreted with caution. Most of these studies have used some form of quantitative questionnaire to determine foot care knowledge and foot self care behaviours. Stuart and Wiles (1998) showed that structured questionnaires overestimated foot care knowledge compared to qualitative interviews.
The degree of adherence to one aspect of the diabetes self-management regimen (eg dietary patterns) has been shown not to be related to adherence to other aspects of the regimen (eg glucose testing) and different psychosocial variables predicted adherence to different regimen components (Schaffer et al, 1983). Research on adherence to self-care guidelines for the foot needs to be interpreted in this context.
There are a number of shortcomings of the traditional compliance or adherence approach with a more psychosocial approach being recently advocated. Adherence is the extent to which a person’s behaviour coincides with medical or health advice. Anderson (1985) believes the constructs ‘compliance’ and ‘adherence’ are problematic as they both construed the problem to be patient behaviour. ‘Self management’ terminology is being widely adopted as preferable to terms ‘compliance’ and ‘adherence’ (Glasgow & Anderson, 1999). Unlike many other illness’s people with diabetes have to take almost full responsibility for the management of the disease. Important choices made on a daily basis affect their well being and they are in control of this and the consequences of the choices accrue to the person with diabetes.
The management of patients with diabetic foot disease risk factors needs to take place in this changing context from the ‘adherence’ and ‘compliance’ paradigm to the much more positive ‘self-management’ paradigm. Patients need to be informed of the positive choices that they can make in self-management to contribute to their care.
Payne CB: Medical model perspective on the psychosocial and behavioural aspects of diabetic foot complications. Australasian Journal of Podiatric Medicine 34(2)55-60 2000
__________________ Craig Payne
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