Treatment results and quality of life of patients with diabetic foot
- Authors: Fedortsova T.1
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Affiliations:
- ФГБОУ ВО КГМУ Министерства здравоохранения Российской Федерации
- Issue: Vol 9 (2020): Материалы XVI Международной Бурденковской научной конференции 23-25 апреля 2020 года
- Pages: 424-425
- Section: Хирургические дисциплины
- URL: https://new.vestnik-surgery.com/index.php/2415-7805/article/view/6142
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Abstract
The relevance of the study is that diabetes is a fairly common problem today, which affects about 10 million people. Speaking of diabetic foot, it should be noted that in the Russian Federation from 90 to 200 thousand patients with diabetes suffer from foot ulcers. More than 40% of all amputations of limbs that are not associated with mechanical trauma are performed precisely because of the development of diabetic gangrene. Materials and methods were used for statistical analysis of treatment results and questionnaires of patients treated at the Kursk city clinical hospital of emergency medical care. During the study, two groups of patients were formed: 10 people with neuropathic foot form and 10 people with ischemic foot form. The analysis of the results obtained by SF-36 questionnaire revealed that significantly reduces the quality of life of patients with ischemic form of diabetic foot, in particular the "Physical health component" in 1,8 times less, than patients of the first group. This decrease can be explained by the fact that patients in the second group in most cases were prescribed radical treatment – amputation. It significantly reduces a person's physical activity and also adversely affects their psychoemotional state, as evidenced by a decrease in the "Psychological component of health" indicator by almost 1.4 times. In conclusion, we can say that the Ischemic form of diabetic foot, in comparison with the neuropathic form, has a more negative impact on the quality of life of patients.
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RELEVANCE. Diabetes mellitus is a fairly common problem today, affecting about 10 million people [1]. This pathology often leads to the formation of late complications, one of which is diabetic foot syndrome. Speaking of diabetic foot, it should be noted that in the Russian Federation from 90 to 200 thousand patients with diabetes suffer from foot ulcers. More than 40% of all amputations of limbs that are not associated with mechanical trauma are performed precisely because of the development of diabetic gangrene [2].
Objective: to evaluate the effectiveness of treatment and quality of life in patients with neuropathic and ischemic forms of diabetic foot.
Methods: statistical analysis of the results of treatment and questionnaires of patients who were treated on the basis of the Kursk city clinical hospital of emergency medical care. 15 women and 5 men aged 58 to 85 were interviewed. During the study, two groups of patients were formed: 10 people with neuropathic foot form and 10 people with ischemic foot form. The distribution of patients by gender and age is shown in table 1.
Among the patients of the first group, women aged 71 to 75 years (30%) predominate, and among the patients of the second group – women aged 76 to 85 years (60%). This distribution among men is statistically unreliable.
In the first group, patients with type 2 diabetes at the stage of subcompensation prevailed (50%), and in the second group – patients with type 2 diabetes at the stage of decompensation (70%). The compensated stage of DM was not observed in any of the cases.
The examination of patients included laboratory tests of General blood and urine tests, biochemical blood tests, blood glucose tests; instrumental studies-ECG, ORGOGC, ultrasound of internal organs (liver, kidneys, pancreas, gall bladder), reovasography of the lower extremities and consultations with an optometrist, endocrinologist and diabetologist.
The quality of life assessment was based on the SF-36 questionnaire.
Results. Analysis of the frequency of clinical symptoms is presented
The first group of patients is characterized by loss of sensitivity (100%) and the presence of trophic ulcers of the lower extremities (100%) (at the level of the metatarsal heads), and the second group – necrosis of the phalanges of the fingers (100%) and intermittent lameness (100%).
Analysis of the frequency of degrees of circulatory disorders based on reovasography of the lower extremities is presented in table 4.
In patients of the second group, the stage of decompensation of circulatory disorders prevails (90%). In the first group, the subcompensation stage is more common (70%).
In the neuropathic form, foot relief, local conservative treatment with antiseptic agents (chlorhexidine, an aqueous solution of iodopirone, levomicol), antibiotic therapy (cephalosporins of the 3rd generation, ciprofloxacin), hypoglycemic therapy (gliformin, insulin) were performed. Treatment of the ischemic form of diabetic foot in 100% of cases consisted in amputation of the affected area of the foot with necroectomy, tendoectomy, drainage of purulent congestion. Along with this, hypoglycemic agents and anticoagulants (heparin) were also prescribed.
The results of the survey of patients are presented in table 5.
Discussion. Table 5 shows that the quality of life of patients with an ischemic form of diabetic foot is significantly reduced, in particular, the" Physical component of health " is 1.8 times less than in patients of the first group. This decrease can be explained by the fact that patients in the second group in most cases were prescribed radical treatment – amputation. It significantly reduces a person's physical activity and also adversely affects their psychoemotional state, as evidenced by a decrease in the "Psychological component of health" indicator by almost 1.4 times.
Conclusion. The ischemic form of diabetic foot, in comparison with the neuropathic form, has a more negative impact on the quality of life of patients.
About the authors
Tatyana Fedortsova
ФГБОУ ВО КГМУ Министерства здравоохранения Российской Федерации
Author for correspondence.
Email: tanya_fedorzova@mail.ru
ORCID iD: 0000-0003-4568-842X
SPIN-code: 6274-3316
Russian Federation, г. Курск, ул. Карла Маркса 3
References
- Белозерцева Ю.П., Курлаев П.П., Гриценко В.А. Синдром диабетической стопы: этиология, патогенез, классификации и лечение // Курский научно-практический вестник «Человек и его здоровье». Курск, 2016.
- № 1. С.69-78.
- Клинико-функциональные и метаболические нарушения и их коррекция у пациентов с дистальной сенсомоторной нейропатией / Нечипуренко Н.И., Пашковская И.Д., Ласков В.Б [и др.] // Курский научно-практический вестник «Человек и его здоровье». Курск, 2017. № 2. С. 55-64.