AIM: A diabetes-related foot ulcer (DFU) is a major risk factor for lower-extremity amputation (LEA). To help clinicians predict the risk of LEA in people with DFU, the Diabetic Foot Risk Assessment (DIAFORA) system was developed but has never been externally validated. METHODS: In this study, 317 people presenting with a new DFU were included. At baseline, participants were grouped into three groups based on their DIAFORA score: low-risk (<15), medium-risk (15-25), and high-risk (>25). Participants were followed until healing, LEA, death, or at least 3 months. Discriminative accuracy was evaluated using sensitivity, specificity, likelihood ratios (LRs) and the area under the curve (AUC). RESULTS: All 317 participants completed at least 3 months of follow-up for a median duration of 146 days, during which 12.6% underwent minor amputation and 2.5% major amputation. People in the low- and medium-risk categories had major amputation rates of 0.9% and 2.1%, respectively, and negative LR of major LEA of 0.10 and 0.38, respectively, while the people in the high-risk category had an amputation rate of 25.0% and a positive LR of 12.9. The DIAFORA risk groups had a sensitivity of 75.0% and a specificity of 65.7%, with a corresponding AUC of 0.78 (95% CI 0.68-0.87) for the prediction of major LEA. CONCLUSION: The DIAFORA score is a useful tool for risk stratification of people presenting with a newly occurred DFU, with the external validation presenting results similar to those presented in the original study. The DIAFORA score may guide clinicians towards more individualized DFU treatment regimens.
- MeSH
- amputace * statistika a číselné údaje MeSH
- diabetická noha * chirurgie epidemiologie MeSH
- dolní končetina chirurgie MeSH
- hodnocení rizik metody MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- prediktivní hodnota testů MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- validační studie MeSH
- Geografické názvy
- Dánsko MeSH
Diabetes mellitus is a chronic disease affecting glucose metabolism. The pathophysiological reactions underpinning the disease can lead to the development of late diabetes complications. The gut microbiota plays important roles in weight regulation and the maintenance of a healthy digestive system. Obesity, diabetes mellitus, diabetic retinopathy, diabetic nephropathy and diabetic neuropathy are all associated with a microbial imbalance in the gut. Modern technical equipment and advanced diagnostic procedures, including xmolecular methods, are commonly used to detect both quantitative and qualitative changes in the gut microbiota. This review summarises collective knowledge on the role of the gut microbiota in both types of diabetes mellitus and their late complications, with a particular focus on diabetic foot syndrome.
- MeSH
- diabetes mellitus * MeSH
- diabetická noha * MeSH
- diabetická retinopatie * MeSH
- diabetické nefropatie * etiologie MeSH
- lidé MeSH
- obezita MeSH
- střevní mikroflóra * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Inhibítory sodíko-glukózového kotransportéra 2 (SGLT2i), resp. gliflozíny sú modernou skupinou antidiabetických liekov v liečbe pacientov s diabetes mellitus 2. typu (DM2T). Kanagliflozín okrem dobrej glykemickej kontroly, nízkeho rizika hypoglykémie a poklesu telesnej hmotnosti vykazuje signifikantný kardiovaskulárny a nefroprotektívny benefit v liečbe pacientov s DM2T porovnateľný s ostatnými gliflozínmi (empagliflozín, dapagliflozín). Liečba kanagliflozínom sa môže potenciálne spájať s nižším rizikom cievnej mozgovej príhody dôsledkom inhibície SGLT1. Výskyt nežiaducich účinkov, ako sú zvýšené riziko infekcie močových ciest, najmä vaginálne kandidózy u žien, euglykemická ketoacidóza a deplécia objemu spojená s hypotenziou, je porovnateľný v celej skupine gliflozínov.
Sodium-glucose co-transporter 2 (SGLT2) inhibitors, gliflozins are a modern class of diabetic medications in the treatment of patients with type 2 diabetes mellitus (T2DM). Apart from good glycemic control, low risk of hypoglycemia and weight loss, canagliflozin has been shown to provide significant cardiovascular and nephroprotective benefit in patients with T2DM co-equal to other gliflozines (empagliflozin, dapagliflozin). Treatment with canagliflozin is potentially associated with lower risk of stroke due to inhibition of SGLT1. Incidence of adverse side effects such as increased risk of urinary infections, mainly vaginal candidosis in female, euglycemic ketoacidosis and volume depletion with hypotension is comparable in whole group of gliflozines.
- MeSH
- canagliflozin * aplikace a dávkování farmakologie terapeutické užití MeSH
- chronická renální insuficience farmakoterapie prevence a kontrola MeSH
- diabetes mellitus 2. typu farmakoterapie MeSH
- diabetické nefropatie farmakoterapie prevence a kontrola MeSH
- glifloziny farmakologie terapeutické užití MeSH
- kardiovaskulární nemoci farmakoterapie prevence a kontrola MeSH
- lidé MeSH
- nemoci ledvin farmakoterapie prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- Klíčová slova
- bempedová kyselina,
- MeSH
- ezetimib terapeutické užití MeSH
- hypolipidemika * aplikace a dávkování ekonomika farmakologie terapeutické užití MeSH
- kardiovaskulární nemoci * farmakoterapie komplikace mortalita prevence a kontrola MeSH
- klinická studie jako téma MeSH
- kombinovaná farmakoterapie metody MeSH
- komplikace diabetu MeSH
- kongresy jako téma MeSH
- krevní glukóza účinky léků MeSH
- LDL-cholesterol krev účinky léků MeSH
- lidé MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- statiny terapeutické užití MeSH
- Check Tag
- lidé MeSH
- MeSH
- ateroskleróza * farmakoterapie komplikace MeSH
- hypolipidemika terapeutické užití MeSH
- kardiovaskulární nemoci farmakoterapie komplikace prevence a kontrola MeSH
- klinická studie jako téma MeSH
- komplikace diabetu MeSH
- kongresy jako téma * MeSH
- lidé MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- zprávy MeSH
Diabetic foot (DF) can develop in diabetic patients after organ transplantation (Tx) due to several factors including peripheral arterial disease (PAD), diabetic neuropathy and inappropriate DF prevention. Aim: To assess the occurrence of DF and associated risk factors in transplant patients. Methods: Fifty-seven diabetic patients were enrolled as part of this prospective study. All patients underwent organ Tx (01/2013-12/2015) and were followed up for minimum of 12 months up to a maximum of 50 months. Over the study period we evaluated DF incidence and identified a number of factors likely to influence DF development, including organ function, presence of late complications, PAD, history of DF, levels of physical activity before and after Tx, patient education and standards of DF prevention. Results: Active DF developed in 31.6% (18/57) of patients after organ Tx within 11 months on average (10.7 ± 8 months). The following factors significantly correlated with DF development: diabetes control (p = .0065), PAD (p<0.0001), transcutaneous oxygen pressure (TcPO2;p = .01), history of DF (p = .0031), deformities (p = .0021) and increased leisure-time physical activity (LTPA) before Tx (p = .037). However, based on logistic stepwise regression analysis, the only factors significantly associated with DF during the post-transplant period were: PAD, deformities and increased LTPA. Education was provided to patients periodically (2.6 ± 2.5 times) during the observation period. Although 94.7% of patients regularly inspected their feet (4.5 ± 2.9 times/week), only 26.3% of transplant patients used appropriate footwear. Conclusions: Incidence of DF was relatively high, affecting almost 1/3 of pancreas and kidney/pancreas recipients. The predominant risk factors were: presence of PAD, foot deformities and higher LTPA before Tx. Therefore, we recommend a programme involving more detailed vascular and physical examinations and more intensive education focusing on physical activity and DF prevention in at-risk patients before transplantation.
- MeSH
- cvičení fyziologie MeSH
- diabetická noha * epidemiologie prevence a kontrola etiologie MeSH
- dospělí MeSH
- hodnocení rizik metody MeSH
- incidence MeSH
- lidé středního věku MeSH
- lidé MeSH
- pooperační komplikace epidemiologie prevence a kontrola etiologie MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- transplantace ledvin * škodlivé účinky metody MeSH
- transplantace slinivky břišní * škodlivé účinky metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Komplikace diabetu souvisí s dlouhodobě neuspokojivou kompenzací diabetu, kterou obvykle hodnotíme podle koncentrace glykovaného hemoglobinu (HbA1c). Kolísání hodnot koncentrace glukózy v krvi je spojeno s oxidačním stresem, dysfunkcí endotelu a zánětem, což jsou faktory tradičně spojené s patogenezí vaskulárního poškození. Variabilita koncentrace glukózy byla ve studiích spojena s makrovaskulárními komplikacemi, její souvislost s mikrovaskulárními komplikacemi je však nejasná. Hlavní otázkou zůstává, zda by se měla krátkodobá variabilita glukózy považovat za nezávislý rizikový faktor pro mikrovaskulární komplikace diabetu. Tento přehled shrnuje poznatky v oblasti variability glukózy a její možný vztah k diabetické retinopatii, nefropatii a neuropatii. Současná data ukazují na potřebu dalšího výzkumu parametrů jak krátkodobé, tak dlouhodobé variability glukózy. Tyto parametry variability mohou být důležité pro výběr optimálních léčebných strategií a také pro odhad rizika chronických diabetických komplikací.
Microvascular diabetes complications are linked to inadequate long-term diabetes control, as indicated by glycated haemoglobin (HbA1c) levels. Fluctuations in glucose levels are connected to oxidative stress, endothelial dysfunction, and inflammation, all of which are traditionally linked to the development of vascular damage. While some studies have linked glucose variability to macrovascular disease, its association with microvascular disease is still debated. The major question is whether short-term glucose variability should be regarded as an independent risk factor for microvascular complications in diabetes. This summary reviews research on glucose variability and its potential connections to diabetic retinopathy, nephropathy, and neuropathy. Current data indicate the need for further research into the parameters of both short-term and long-term glucose variability. These variability parameters may be important for selecting optimal treatment strategies and for estimating the risk of chronic diabetic complications.
- MeSH
- diabetes mellitus MeSH
- diabetické angiopatie metabolismus MeSH
- glykovaný hemoglobin * metabolismus MeSH
- komplikace diabetu * MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
