Apelqvist Jan
Department of Endocrinology, University Hospital of Malmö, University of Lund, S-205 02 Malmö, Sweden.
Diabetes Metab Res Rev. 2008 May-Jun;24 Suppl 1:S110-5. doi: 10.1002/dmrr.834.
The diabetic foot constitutes a tremendous challenge for patients, caregivers and the health care system. The International Consensus Document of 1999 was a milestone in the recognition of the importance and consequences of the diabetic foot. Since then, many original papers have been published in this area. Large cohort studies have given us a deeper understanding regarding factors related to the outcome of diabetic foot ulcers: according to these studies, the severity of diabetic foot ulcers is greater than previously reported. More than 50% of individuals' foot ulcers have signs of infection at admission, and one-third have signs of both peripheral artery disease (PAD) and infection. The co-morbidities increase significantly with increasing severity of the foot disease. However, the trend in all these studies is a successive improvement in healing rate (50-60% at 20 weeks follow-up, > 75% at 1 year). It is important to differentiate between neuropathic and neuro-ischaemic ulcers with regard to factors related to outcome and co-morbidities.Recent research has emphasized the importance of psychological factors in the development and outcome of diabetic foot ulcers. Studies have shown that perceptions of the individual's own risks based on symptoms, and their own beliefs in the efficacy of self-care, can affect foot-care practice.The importance and influence of the health care organization and reimbursement should not be underestimated, both in the prevention and management of diabetic foot lesions. The diabetic foot should be considered a lifelong condition, as having had one ulcer dramatically increases the risk of developing a new ulcer. In an individual with diabetes and a foot ulcer, the ulcer should be considered as a sign of multi-organ disease, and a holistic approach to both management and prevention is recommended.
糖尿病足给患者、护理人员及医疗保健系统带来了巨大挑战。1999年的国际共识文件是认识糖尿病足重要性及后果的一个里程碑。自那时起，该领域发表了许多原创论文。大型队列研究使我们对与糖尿病足溃疡预后相关的因素有了更深入的了解：根据这些研究，糖尿病足溃疡的严重程度比之前报道的更高。超过50%的患者足部溃疡在入院时有感染迹象，三分之一同时有外周动脉疾病（PAD）和感染迹象。随着足部疾病严重程度的增加，合并症显著增多。然而，所有这些研究的趋势是愈合率不断提高（20周随访时为50 - 60%，1年时>75%）。在与预后和合并症相关的因素方面，区分神经性溃疡和神经缺血性溃疡很重要。最近的研究强调了心理因素在糖尿病足溃疡发生和预后中的重要性。研究表明，个体基于症状对自身风险的认知以及对自我护理效果的信念会影响足部护理行为。在糖尿病足病变的预防和管理中，医疗保健组织和报销的重要性及影响不应被低估。糖尿病足应被视为一种终身疾病，因为有过一次溃疡会显著增加发生新溃疡的风险。对于患有糖尿病和足部溃疡的个体，该溃疡应被视为多器官疾病的一个迹象，建议采用整体的管理和预防方法。
