Today, guidance endorsed by the American Limb Preservation Society, entitled Nutrition Interventions in Adults with Diabetic Foot Ulcers,* was released highlighting the impact of nutrition-focused therapy in wound healing for adults living with diabetes who experience diabetic foot ulcers (DFU).

The development of this guidance was the collaborative effort of a multidisciplinary team of medical professionals including–a podiatrist, registered dietitian, vascular surgeon and general/plastic surgeon. As a leader in science-based nutrition, Abbott supported the printing and distribution of this new guidance and has a long track record of research in wound-care therapy. 

“The guidance reinforces nutrition therapy, which is an often-overlooked part of wound care that can help provide patients with early and aggressive intervention,” said David G. Armstrong, M.D., guidance co-author, founding president of the American Limb Preservation Society, professor of surgery at Keck School of Medicine of University of Southern California and a part of Abbott’s speakers bureau. “When clinicians take the time to engage with patients in a meaningful exchange of information and help manage glucose levels, quality of life and adherence are improved.”

In the U.S., more than 30% of people living with diabetes are at risk for developing a foot ulcer. Healing from DFU requires proper nutrition.** This guidance highlights that when patients receive nutrition education and are treated with nutrition intervention, they can incorporate the right nutrients in their diet to support the wound-healing process.

Proper diet alone may be insufficient for patients to experience optimal healing for wounds, including diabetic foot ulcers. Ensuring sufficient hydration, protein, calories, and micronutrients like amino acids, vitamins and minerals, as well as tracking daily glucose targets, better supports the wound-healing process and allows patients to generate new tissue at the wound site.

“Historically, nutrition guidance to help support the healing of foot ulcers in people with diabetes has been limited,” said Maritza Molina, guidance co-author and registered dietitian nutritionist. “Patients with diabetes may develop a series of health issues over time if their diabetes is not well controlled. Glycemic control is the first and foremost goal, making medical nutrition therapy an important part of diabetes management.”

The guidance states that if someone cannot meet estimated nutrient needs with diet alone, targeted nutritional therapy is recommended. Oral nutritional supplements can be an option for supplying the nutrients necessary to support optimal wound healing.

While primarily serving as guidance for clinicians, this tool is also a resource for people living with diabetes and stresses the importance of nutrition education, regular screening for nutritional deficiencies, and the importance of working with their healthcare team to create an individualized care plan.

Low-cost sensor-insoles can be used to assess the risk of foot ulcers CREDIT Staffordshire University

Millions of people with diabetes are at risk of developing foot ulcers, which often lead to amputations and other health complications. Now, Scientists from the Centre for Biomechanics and Rehabilitation Technologies (CRBT) have developed a new method to reliably detect this risk without the need for complex electronic in-shoe sensors.

Dr Panagiotis Chatzistergos, Associate Professor in Orthopaedic Biomechanics, explained: “In the UK alone, 169 people have a toe, foot or limb amputated as a result of diabetes every week, yet importantly up to 80% of these amputations could have been prevented with correct management.

“Routine overloading of the sole of the foot during daily activities can trigger the onset of foot ulcers, so being able to identify which areas in the sole of the foot are most affected is extremely important.”

A common method involves assessing plantar pressure to prescribe special footwear or insoles, however many clinicians cannot use this because it is expensive and difficult to use. Dr Chatzistergos and colleagues have developed a novel concept to address this problem, using 3D-printed, tuneable structures that will help clinicians better understand the cause of ulcer development and lead to improved patient outcomes.

Dr Chatzistergos, who led the study, said: “Our work has demonstrated a method to reliably detect overloading using a low-cost non-electronic technique. We have used a 3D-printed thin-wall structure that changes its properties when repeatedly loaded above or below a tuneable threshold. We believe that this is a step change from current practice.”

Patients would be required to wear the sensor-insoles in their everyday footwear for a representative time period, for example a day or a week, before returning them for analysis. During the analysis of the sensor-insole, plantar areas that were routinely subjected to higher pressures should be identifiable, against those where pressure was below that threshold.

The concepts behind the work, published in Royal Society Open Science, have been fully developed at Staffordshire University and the intellectual property has been protected.

Professor Nachi Chockalingam, Director for CRBT who co-authored the study, said: “Plantar pressure assessment is common amongst clinical practice and it contributes to insoles and footwear prescription. However, the current technologies are expensive and difficult to use in an everyday clinic.

“Each year more than 26 million people worldwide develop diabetic foot ulcers and the lifetime incidence of foot ulcers in developing countries is more than 20% among people with diabetes. Establishing low-cost methods to help prevent foot ulcers will reduce the global socioeconomic burden of diabetes and ultimately save lives. The concept reported within this paper, with further development, has the potential to transform clinical management of foot ulcer risk across the world.”

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