Medical School, University of Western Australia, Fiona Stanley Hospital, Murdoch and Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
Central Clinical School, Sydney Medical School, the Faculty of Medicine and Health, University of Sydney and Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
J Endocrinol. 2023 May 2;257(3). doi: 10.1530/JOE-22-0238. Print 2023 Jun 1.
Diabetes-related foot disease (DFD), defined as ulceration, infection or destruction of tissues of the foot in a person with current or previously diagnosed diabetes mellitus, is associated with a heavy burden for both patients and the healthcare system with high morbidity, mortality and costs. Improved outcomes for people with DFD are achieved with an interdisciplinary approach and adherence to best practice clinical guidelines; however, in the Australian context, the vastness of the country presents unique challenges in achieving optimal outcomes for all people with DFD, with variation in service delivery, availability and accessibility between metropolitan, rural and remote areas. Aboriginal and Torres Strait Islander Australians and people with diabetes living in rural and remote areas experience higher rates of lower-extremity amputation, and further efforts and resources are required to improve outcomes for these high-risk groups. In recent years, there have been advances in knowledge, including the understanding of the pathogenesis of diabetes-related peripheral neuropathy, genetic polymorphisms and mechanisms of disease associated with acute Charcot neuroarthropathy, biomarkers and potential mediators of diabetes-related foot ulcer (DFU) healing, the microbiology and microbiome profile of DFUs, pressure assessment and management as well as an expanded understanding of DFU sequelae and comorbidities. In this review, we describe new insights into pathophysiology, sequelae and comorbidities of DFD with a focus on basic and translational aspects and contributions to the field from Australian and New Zealand DFD researchers.
糖尿病相关足部疾病（DFD）定义为患有当前或先前诊断为糖尿病的个体足部溃疡、感染或组织破坏，给患者和医疗保健系统带来了沉重负担，发病率、死亡率和医疗成本都很高。通过跨学科方法和遵循最佳实践临床指南，可以实现 DFD 患者的更好结果；然而，在澳大利亚的背景下，该国地域辽阔，在所有 DFD 患者中实现最佳结果存在独特的挑战，大都市、农村和偏远地区之间的服务提供、可用性和可及性存在差异。澳大利亚原住民和托雷斯海峡岛民以及居住在农村和偏远地区的糖尿病患者下肢截肢率更高，需要进一步努力和资源来改善这些高风险群体的结果。近年来，在知识方面取得了进展，包括对糖尿病相关周围神经病变发病机制的理解、与急性夏科氏神经关节病相关的遗传多态性和疾病机制、糖尿病相关足部溃疡（DFU）愈合的生物标志物和潜在介质、DFU 的微生物学和微生物组特征、压力评估和管理，以及对 DFU 后遗症和合并症的更深入理解。在这篇综述中，我们描述了 DFD 的病理生理学、后遗症和合并症的新见解，重点介绍了基础和转化方面以及澳大利亚和新西兰 DFD 研究人员对该领域的贡献。
