Prevention of lower-limb lesions and reduction of morbidity in diabetic patients

• Published in: Revista brasileira de ortopedia 2014-09, Vol.49 (5), p.482-487
• Main Authors: do Amaral Júnior, Antônio Homem, do Amaral, Leonã Aparecido Homem, Bastos, Marcus Gomes, do Nascimento, Luciana Campissi, Alves, Marcio José Martins, de Andrade, Marco Antonio Percope
• Format: Article
• Language: English
• Subjects: Amputation; Amputação; Diabetes mellitus; Diabetic neuropathies; Doencas vasculares periféricas; Doenças vasculares periféricas; Foot; Infection; Infecção; Neuropatias diabéticas; Neuropatías diabéticas; Original; ORTHOPEDICS; Peripheral vascular diseases; Prevenção primária; Primary prevention; Ulcer; Úlcera
• ISSN: 2255-4971; 1982-4378; 2255-4971
• DOI: 10.1016/j.rboe.2014.06.001

To assess the impact of a diabetic foot outpatient clinic on reducing the morbidity of this disease, with emphasis on lower-limb lesions. This was a prospective observational study with a target population of 30 cases out of a total of 77 patients in the diabetic foot outpatient clinic. The inclusion criterion was that data relating to laboratory tests, clinical examinations, neuropathic and vascular tests and the elbow-arm index needed to be available from all the patients, with repetition after 18 months of follow-up, so as to analyze their evolution. The statistical analysis was done using the McNemar chi-square test for dependent samples. The patients’ mean age was 61 years. All of them had type 2 diabetes mellitus (DM), which had started 14.5 years previously, on average, and 20% had neuropathies. After 18 months, there was no change in the frequency of lesions in diabetes target organs (p=1.000) or in the neuropathy rate (p=1.000). However, there were significant improvements in neuropathic symptoms, from 70% to 36.7% (p=0.035), and in peripheral arterial disease, from 73.3% to 46.7% (p=0.021). There was also a decrease in ulcers from 13.3% to 10% (p=1.000). Creation of specialized outpatient clinics for prevention of diabetic foot is a viable investment, which has low cost compared with the high costs generated through the complications from this disease. This approach noticeably improves the patients’ quality of life, with reduction of morbidity. Avaliar o impacto de um ambulatório de pé diabético na redução da morbidade da doença, com ênfase nas lesões dos membros inferiores. Estudo prospectivo, observacional, com população alvo de 30 casos do total de 77 pacientes do ambulatório de pé diabético. O critério de inclusão foi que todos os pacientes tivessem exames laboratoriais, exame clínico, testes neuropático e vascular e índice tornozelo-braço repetidos após 18 meses de acompanhamento, o que permitiu analisar sua evolução. A análise estatística foi feita com o teste qui-quadrado de MacNemar para amostras dependentes. A média de idade dos pacientes foi de 61 anos, todos portadores de diabetes mellitus (DM) tipo 2, iniciada em média havia 14.5 anos, e 20% eram neuropatas. Após 18 meses, não houve mudança na frequência de lesão em órgão alvo da diabetes (p=1000) e no índice de neuropatia (p=1000). Obteve-se, no entanto, melhoria significativa dos sintomas neuropáticos de 70% para 36.7% (p=0.035), bem como da doença arterial periférica de 73.3% para