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The Foot in Diabetes - part 2

Mặc dù UKPDS đề nghị kiểm soát chặt chẽ đường huyết và huyết áp có thể ¯ uence sự phát triển của thiết bị đầu cuối tim mạch, chẳng hạn như cái chết đột quỵ và đột ngột, bằng chứng thống kê rằng những ¯ uence sự tiến triển của PVD không forthcoming13, 14. | The Pathway to Ulceration 21 Figure 3.1 Pathways to foot ulceration in diabetic patients Although the UKPDS suggested that tight control of blood glucose and blood pressure might influence the development of certain cardiovascular endpoints such as stroke and sudden death statistical evidence that these influence the progression of PVD was not forthcoming13 14. However educational strategies aimed at the cessation of smoking and control of dyslipidaemia therefore remain of paramount importance. Moreover in view of trends observed in the United Kingdom Prospective Diabetes Study UKPDS optimal glycaemic and blood pressure control should be aimed for. DIABETIC NEUROPATHY The diabetic neuropathies are a heterogenous group of conditions that may be subclassified into various polyneuropathies and mononeuropathies on clinical grounds15. The association between peripheral neuropathy and foot ulceration has been recognized for many years Pryce a surgeon working in Nottingham over 100 years ago remarked that it is abundantly clear to me that the actual cause of the perforating ulcer was a peripheral nerve degeneration and diabetes itself may play an active part in the causation of the perforating ulcers . It is the sensory and the peripheral autonomic polyneuropathies that play an important role in the pathogenesis of ulceration and these will be discussed in some detail. 22 The Foot in Diabetes Table 3.1 Epidemiological data on diabetic peripheral sensorimotor neuropathy Reference Country Number of subjects Type of Diabetes Prevalence Reference Population-based studies 17 UK 811 2 41.6 17 18 Finland 133 2 8.3a 41.9b 18 Clinic-based studies 19 UK 6487 1 2 28.5 19 20 Europe 3250 1 28.0 20 21 Spain 2644 1 2 22.7 21 aAt diagnosis. bAfter 10 years. Sensory Neuropathy Chronic sensorimotor neuropathy is by far the commonest of all the diabetic neuropathies and occurs in both main types of diabetes. An internationally agreed definition is the presence of symptoms and or signs of .