Keeping Patients With Diabetic Foot Ulcers In Remission

The presence of a diabetic foot ulcer (DFU) often leads to re-ulceration. A new study in the International Journal of Lower Extremity Wounds notes that the complication of DFUs will require more healthcare resources and also reaffirms the importance of podiatric physicians in keeping patients with ulcers in remission.¹

The study cites data suggesting that removing preventative podiatric care from statewide reimbursement systems led to significant and sustained increases in hospital admission, charges, length of stay, and severe aggregate outcomes including amputation, sepsis and death.¹ My co-authors and I noted that comorbidities including peripheral artery disease, poor nutrition and non-adherence to preventive therapies make the chance of ulcer recurrence more likely, and also raise the cost of care and chance of hospital admission. To increase the chances of patients having remission from ulceration, our study emphasizes the importance of novel offloading and wearable sensor technologies, appropriate follow-up care, shoe and insole modification, and patient education.

I believe strongly that we can reduce the risk for severe re-ulceration and recurrence. There are a number of very exciting technologies. We have been working with thermometry for more than 20 or 30 years now, a technology that has worked its way into the home in the form of a bath mat that can identify a hot spot on the foot and also tell the patient’s doctor and nurse. I can see our patients subscribing to services like this in the not too distant future and these kind of technologies can help identify problems and reduce the risk for ulcer recurrence.

Reference

1. Miller JD, Salloum M, Button A, Giovinco NA, Armstrong DG. How can I maintain my patient with diabetes and history of foot ulcer in remission? Int J Lower Extremity Wounds. 2014; 13(4):371-77.