Not all articles in the DMRR special issue have an exclusive focus on diabetic foot disease
These articles are a good reminder that it’s not just about ‘treating the hole in the patient (the ulcer), but about treating the whole of the patient’. Perkasis and Vanderwoude describe the concepts of frailty and sarcopenia. Frailty is a state of increased vulnerability, which can be physical or psychological, and may improve or worsen over time. The importance of early recognition of frailty and sarcopenia, especially in people with diabetes, is stressed, since frailty and sarcopenia can be managed. Adequate management could slow down the emergence of dependency, especially when foot ulcers or amputations may also be present.
Egan and Dinneen discuss the pros and cons of general metabolic regulation in hospitalized patients with diabetes. They argue that international guidelines should be followed, describing pre-meal glucose targets of <7.8 mmol/L and random targets <10.0mmol/L. These goals will avoid significant hyperglycaemia, while minimizing the hypoglycaemia risks. Despite foot ulcers being the most frequent cause for hospitalization, unfortunately the effects of glucose control on these patients have not been investigated specifically to date.
Finally, Prof Dunning brings us towards the final stages of life: palliative care. The first eye opening statement is her emphasis on considering palliative care rather early in the course of chronic disease, something that is stressed by the WHO but rarely done by clinicians. Given the increased mortality found in people with diabetes and a foot ulcer, palliation and risk management can have significant benefits in their quality of life. The aim of such palliative care would be to stabilize the wound, reduce the wound volume and provide less burden-some wound care. These plans should be carefully discussed with patients and their family, to explain the change from curative to palliative care. Despite the limited evidence for foot ulcers specifically, Prof Dunning makes a strong case for clinicians working in this field to learn and do more with regard to palliative care.
http://onlinelibrary.wiley.com/doi/10.1002/dmrr.2743/abstract http://onlinelibrary.wiley.com/doi/10.1002/dmrr.2741/abstract http://onlinelibrary.wiley.com/doi/10.1002/dmrr.2758/abstract