MB, BCh BAO, CHIA, FRACGP, Graduate Researcher, Department of General Practice, University of Melbourne, Vic; General Practitioner, Parkville Precinct Medical, Vic.
Dip Pod, MSc (Med), Director of Podiatry, Podiatry Department, Sydney Local Health District, Sydney, NSW; The University of Sydney Central Clinical School, University of Sydney, Sydney, NSW.
Aust J Gen Pract. 2022 Nov;51(11):833-838. doi: 10.31128/AJGP-06-22-6456.
Peripheral neuropathy, peripheral arterial disease and diabetes-related foot ulcers are the most important risk factors for future amputation. Up to 50% of people with diabetes have distal symmetrical polyneuropathy as a complication of diabetes. Distal symmetrical polyneuropathy results in loss of protective sensation in the feet, increasing the risk of diabetes-related foot ulceration.
The aim of this article is to provide structured guidance for detecting diabetes-related peripheral neuropathy, appropriate referral based on risk assessment and prevention of diabetes‑related foot ulceration.
As a result of the often-asymptomatic nature of diabetes-related peripheral neuropathy, general practice is an ideal location for screening all adults with diabetes for loss of protective sensation. Loss of protective sensation in a person with diabetes indicates an at-risk foot. Increased frequency of foot examination, education in self-care, appropriate footwear and referral to podiatry for non‑ulcerative foot problems can reduce the development of diabetes-related foot ulcers.
周围神经病变、周围动脉疾病和糖尿病相关的足部溃疡是未来截肢的最重要危险因素。多达 50%的糖尿病患者存在远端对称性多发性神经病，这是糖尿病的一种并发症。远端对称性多发性神经病导致足部保护性感觉丧失，增加了糖尿病相关足部溃疡的风险。
本文的目的是为检测糖尿病相关周围神经病变、根据风险评估进行适当转诊以及预防糖尿病相关足部溃疡提供结构化指导。
由于糖尿病相关周围神经病变常常无症状，因此全科医疗是筛查所有糖尿病成人保护性感觉丧失的理想场所。糖尿病患者失去保护性感觉表明足部存在风险。增加足部检查的频率、自我护理教育、适当的鞋类以及对非溃疡性足部问题的转介给足病医生，可以降低糖尿病相关足部溃疡的发生。
