An estimated 80% of lower limb amputations in people with diabetes are preventable, a charity has revealed.
In Northern Ireland, there were 199 diabetes-related amputations last year.
A campaign has been launched aimed at putting a stop to preventable amputations.
'Putting Feet First' by Diabetes UK Northern Ireland wants to reduce diabetes-related amputations by 50% within five years.
Diabetes is a serious condition where the amount of glucose in your blood is too high.
People with Type 1 diabetes do not produce any insulin which is needed in order to control the levels of glucose in the blood. Those with Type 2 diabetes produce an insufficient amount of insulin - or can be insulin resistant.
If blood glucose levels are not maintained at normal levels, it can lead to long-term complications such as heart disease, stroke and amputation.
There are currently 73,500 people diagnosed with diabetes in the region.
Iain Foster, the charity's National Director, said: "A single preventable amputation is one too many so the fact that hundreds of people in Northern Ireland have endured unnecessary foot amputations is nothing short of shameful."
Amputations have a devastating effect on quality of life and so every amputation that results from poor healthcare is a tragedy.
Iain Foster
He explained that diabetic foot problems arise from reduced circulation and damaged nerve endings.
He said a big part of bringing this to an end is giving people with diabetes information about how to look after their feet.
The charity wants everyone with diabetes to get a thorough annual foot check and for a specialist diabetes foot care teams for foot ulcers to deal with referrals within 24 hours.
"Many people with diabetes aren't even aware that amputation is a potential complication. We also need to make sure that people with diabetes understand what healthcare they should be getting."
Mr Foster said there are opportunities within the current healthcare system for problems to be detected early - and treatment obtained - before complications set in.
The campaign will include working with healthcare professionals in GP practices and areas, such as A&E departments, to increase awareness of the signs of early complications and the need for a quick referral to specialist staff.
He added: "Quality of care makes a big difference to amputation rates. Foot ulcers can deteriorate in a matter of hours so failing to refer someone quickly enough can literally be the difference between losing a foot and keeping it."
"It is a scandal that needs to be brought to an end."
Showing posts with label exercise and diabetes. Show all posts
Showing posts with label exercise and diabetes. Show all posts
Thursday, June 28, 2012
Saturday, January 28, 2012
Diabetic shoes: Fashion and function
Every day, people willingly trade good foot health for stylish shoes—think stilettos, platforms, and pointy toeboxes. For some time, however, patients who wore diabetic footwear didn’t have the option of worrying about style versus substance.
“When I began practicing years ago there was only one style of [diabetic] shoe and you could tell from across the room it was an orthopedic shoe,” said Crystal Holmes, DPM, CWS, assistant professor in the Department of Internal Medicine at the University of Michigan in Ann Arbor.
Fortunately, diabetic shoes have come a long way, shedding, to some degree, their designation as clunky and unattractive, and are now available in a variety of styles and a rainbow of hues.
With diabetic shoes, the trade-off between fashion and function gets complicated. Holmes and Hillary Brenner, DPM, of Tribeca Private Medical Group in New York City, shared advice for balancing patients’ desire for fashion with clinical concerns.
Sources said women tend to be more focused on style than men. As a result, the Mary Jane has become a staple of diabetic footwear lines, and serves as an example of how aesthetic needs must be weighed against patients’ pathology and lifestyle.
On the whole, experts approve of this shoe style. Holmes said many of her patients like its versatility for everyday, special occasion, and professional looks.
The style can make extra depth look relatively attractive and is compatible with foot orthoses when they are needed. Mary Janes come in cloth or leather, which can accommodate foot deformities.
This style does have drawbacks: The strap across the front may not be suitable for patients with edema or bony prominences, Holmes said.
Brenner isn’t keen on the opening at the top of the shoe and insists patients wear the shoes with socks, stockings, or tights.
In addition, Holmes noted, the toebox can be very wide while the heel tends to be narrow, so foot slippage inside the shoe can be an issue, Holmes said.
Experts who talked with LER said they make a priority of discussing the clinical objectives of diabetic footwear with patients first, then move on to lifestyle issues.
“I certainly would not prescribe the same shoe for a 90-year-old diabetic patient who is a community ambulator who just goes to the market or walks around her home as for a 60-year-old farmer who still works daily on his farm,” Holmes said.
But it’s a safe bet the 90-year-old will be more concerned about fashion than the farmer.
Matching the shoes to the activity is also important, Brenner said. For example, a three-hour sit-down dinner may be a chance for the patient to don a less clinically appropriate, but more attractive, diabetic shoe. In contrast, a full day of walking at a museum calls for wearing prescribed footwear.
“You want to avoid completely taking away options from a patient,” Brenner said.
Options are key when negotiating fashion and fit with patients. Often, patients get their diagnosis and assume it means diabetic shoes are their only choice.
“Just because a person has diabetes doesn’t necessarily mean she’ll need the shoe with the extra depth or the rocker bottom,” Brenner explained. “A younger person with diabetes whose blood sugar is under control may not need that diabetic shoe. On the other hand, an older patient with some balance issues will need a shoe that offers stability and support. It’s not one-style-fits-all for diabetic patients.”
If a patient is determined to wear a certain style, Holmes tenders a compromise.
“I say to them, ‘I’ll let you wear this shoe for six months. During that time, we’ll check your feet regularly. If we see any problems—a spot of irritation—then you have to agree that you’ll stop wearing that shoe and wear the shoe that I prescribe for you,’” she said.
“When I began practicing years ago there was only one style of [diabetic] shoe and you could tell from across the room it was an orthopedic shoe,” said Crystal Holmes, DPM, CWS, assistant professor in the Department of Internal Medicine at the University of Michigan in Ann Arbor.
Fortunately, diabetic shoes have come a long way, shedding, to some degree, their designation as clunky and unattractive, and are now available in a variety of styles and a rainbow of hues.
With diabetic shoes, the trade-off between fashion and function gets complicated. Holmes and Hillary Brenner, DPM, of Tribeca Private Medical Group in New York City, shared advice for balancing patients’ desire for fashion with clinical concerns.
Sources said women tend to be more focused on style than men. As a result, the Mary Jane has become a staple of diabetic footwear lines, and serves as an example of how aesthetic needs must be weighed against patients’ pathology and lifestyle.
On the whole, experts approve of this shoe style. Holmes said many of her patients like its versatility for everyday, special occasion, and professional looks.
The style can make extra depth look relatively attractive and is compatible with foot orthoses when they are needed. Mary Janes come in cloth or leather, which can accommodate foot deformities.
This style does have drawbacks: The strap across the front may not be suitable for patients with edema or bony prominences, Holmes said.
Brenner isn’t keen on the opening at the top of the shoe and insists patients wear the shoes with socks, stockings, or tights.
In addition, Holmes noted, the toebox can be very wide while the heel tends to be narrow, so foot slippage inside the shoe can be an issue, Holmes said.
Experts who talked with LER said they make a priority of discussing the clinical objectives of diabetic footwear with patients first, then move on to lifestyle issues.
“I certainly would not prescribe the same shoe for a 90-year-old diabetic patient who is a community ambulator who just goes to the market or walks around her home as for a 60-year-old farmer who still works daily on his farm,” Holmes said.
But it’s a safe bet the 90-year-old will be more concerned about fashion than the farmer.
Matching the shoes to the activity is also important, Brenner said. For example, a three-hour sit-down dinner may be a chance for the patient to don a less clinically appropriate, but more attractive, diabetic shoe. In contrast, a full day of walking at a museum calls for wearing prescribed footwear.
“You want to avoid completely taking away options from a patient,” Brenner said.
Options are key when negotiating fashion and fit with patients. Often, patients get their diagnosis and assume it means diabetic shoes are their only choice.
“Just because a person has diabetes doesn’t necessarily mean she’ll need the shoe with the extra depth or the rocker bottom,” Brenner explained. “A younger person with diabetes whose blood sugar is under control may not need that diabetic shoe. On the other hand, an older patient with some balance issues will need a shoe that offers stability and support. It’s not one-style-fits-all for diabetic patients.”
If a patient is determined to wear a certain style, Holmes tenders a compromise.
“I say to them, ‘I’ll let you wear this shoe for six months. During that time, we’ll check your feet regularly. If we see any problems—a spot of irritation—then you have to agree that you’ll stop wearing that shoe and wear the shoe that I prescribe for you,’” she said.
Friday, September 9, 2011
More Muscle Mass Knocks Out Insulin Resistance and Prediabetes
Having more muscle mass can protect against insulin resistance and prediabetes, no matter overall body size, researchers said....
In a cross-sectional study, every 10% increase in the ratio of skeletal muscle mass to total body weight was associated with an 11% reduction in risk of insulin resistance and a 12% drop in risk of transitional, prediabetes, or overt diabetes. The findings point to the importance of gauging muscle mass, in addition to other established risk factors such as body mass index (BMI) and waist circumference, when assessing a patient's metabolic health, the researchers said.
The results may also have implications for the role of muscle-building exercises in preventing metabolic dysfunction.
It's known that very low muscle mass (sarcopenia) is a risk factor for insulin resistance, but it's unclear whether increasing muscle mass outside of the sarcopenic range can boost insulin sensitivity or protect against diabetes.
So to determine whether increases in muscle mass are associated with improved glucose regulation, the researchers looked at data on 13,644 patients from the National Health and Nutrition Examination Survey (NHANES) III, conducted from 1988 to 1994.
Patients had data on homeostasis model assessment of insulin resistance (HOMA-IR); glycated hemoglobin (HbA1c); prevalence of transitional, prediabetes, or overt diabetes (PMD); and prevalence of overt diabetes mellitus. These four factors served as the study outcomes.
Muscle mass was assessed via bioelectrical impedance, which measures opposition to the flow of an electric current through body tissues, determining total body water to estimate body composition.
The researchers found that all four of the outcomes declined across quartiles from lowest to highest skeletal muscle index, or the ratio of skeletal muscle to body weight. The smallest effect size was seen for HbA1c, with a 5.8% relative mean reduction between the highest and lowest quartiles.
On the other hand, the most striking effect was in diabetes prevalence, with a relative reduction of 63%. Prevalence was 14.5% in the lowest quartile compared with only 5.3% in the highest, the researchers reported.
After adjusting for confounders including age, ethnicity, sex, and obesity, the relationships persisted for insulin resistance and prevalence of transitional, prediabetes, and overt diabetes.
Specifically, each 10% increase in skeletal muscle index was associated with 11% relative reduction in HOMA-IR and a 12% relative reduction in the combined diabetes endpoint.
After excluding patients with diabetes, these relationships were strengthened. For every 10% increase in muscle mass ratio, there was a 14% reduction in HOMA-IR and a 23% reduction in combined diabetes prevalence.
They explained that the weaker associations when diabetic patients were included were likely due to the effects of diabetes on muscle mass and on pancreatic beta-cell mass.
The researchers concluded that the relationship between muscle mass and insulin resistance was not limited to sarcopenia, as "increases in muscle mass above even average levels were associated with additional protection against insulin resistance and prediabetes."
The study was limited by its cross-sectional nature, and by its use of bioelectrical impedance alone to estimate muscle mass. Also, there was no differentiation between type 1 and type 2 diabetes in the original survey, they said.
As well, patients with high muscle mass tend to have low fat mass, so any of the associations may be due to adipose tissue, they cautioned, although they attempted to control for this.
Despite these findings, prior prospective studies of short-term strength training programs in overweight and obese patients have been unclear in terms of their effects on metabolic abnormalities, they said.
They called for more work to determine the proper duration of exercise interventions needed in order to improve insulin sensitivity and glucose metabolism, and ultimately to have an effect on diabetes incidence.
In a cross-sectional study, every 10% increase in the ratio of skeletal muscle mass to total body weight was associated with an 11% reduction in risk of insulin resistance and a 12% drop in risk of transitional, prediabetes, or overt diabetes. The findings point to the importance of gauging muscle mass, in addition to other established risk factors such as body mass index (BMI) and waist circumference, when assessing a patient's metabolic health, the researchers said.
The results may also have implications for the role of muscle-building exercises in preventing metabolic dysfunction.
It's known that very low muscle mass (sarcopenia) is a risk factor for insulin resistance, but it's unclear whether increasing muscle mass outside of the sarcopenic range can boost insulin sensitivity or protect against diabetes.
So to determine whether increases in muscle mass are associated with improved glucose regulation, the researchers looked at data on 13,644 patients from the National Health and Nutrition Examination Survey (NHANES) III, conducted from 1988 to 1994.
Patients had data on homeostasis model assessment of insulin resistance (HOMA-IR); glycated hemoglobin (HbA1c); prevalence of transitional, prediabetes, or overt diabetes (PMD); and prevalence of overt diabetes mellitus. These four factors served as the study outcomes.
Muscle mass was assessed via bioelectrical impedance, which measures opposition to the flow of an electric current through body tissues, determining total body water to estimate body composition.
The researchers found that all four of the outcomes declined across quartiles from lowest to highest skeletal muscle index, or the ratio of skeletal muscle to body weight. The smallest effect size was seen for HbA1c, with a 5.8% relative mean reduction between the highest and lowest quartiles.
On the other hand, the most striking effect was in diabetes prevalence, with a relative reduction of 63%. Prevalence was 14.5% in the lowest quartile compared with only 5.3% in the highest, the researchers reported.
After adjusting for confounders including age, ethnicity, sex, and obesity, the relationships persisted for insulin resistance and prevalence of transitional, prediabetes, and overt diabetes.
Specifically, each 10% increase in skeletal muscle index was associated with 11% relative reduction in HOMA-IR and a 12% relative reduction in the combined diabetes endpoint.
After excluding patients with diabetes, these relationships were strengthened. For every 10% increase in muscle mass ratio, there was a 14% reduction in HOMA-IR and a 23% reduction in combined diabetes prevalence.
They explained that the weaker associations when diabetic patients were included were likely due to the effects of diabetes on muscle mass and on pancreatic beta-cell mass.
The researchers concluded that the relationship between muscle mass and insulin resistance was not limited to sarcopenia, as "increases in muscle mass above even average levels were associated with additional protection against insulin resistance and prediabetes."
The study was limited by its cross-sectional nature, and by its use of bioelectrical impedance alone to estimate muscle mass. Also, there was no differentiation between type 1 and type 2 diabetes in the original survey, they said.
As well, patients with high muscle mass tend to have low fat mass, so any of the associations may be due to adipose tissue, they cautioned, although they attempted to control for this.
Despite these findings, prior prospective studies of short-term strength training programs in overweight and obese patients have been unclear in terms of their effects on metabolic abnormalities, they said.
They called for more work to determine the proper duration of exercise interventions needed in order to improve insulin sensitivity and glucose metabolism, and ultimately to have an effect on diabetes incidence.
Saturday, June 11, 2011
Lowering Fat Intake Might Stave off Diabetes Even without Weight Loss
Small differences in diet -- even without weight loss -- can significantly affect risk for diabetes....
In this study, 69 healthy, overweight people who did not have diabetes -- but were at risk for it -- were placed on diets with modest reductions in either fat or carbohydrate for eight weeks.
Barbara Gower, Ph.D., professor in the Department of Nutrition Sciences at University of Alabama at Birmingham and lead author of the study noted that, "At eight weeks, the group on the lower fat diet had significantly higher insulin secretion and better glucose tolerance and tended to have higher insulin sensitivity." "These improvements indicate a decreased risk for diabetes."
Gower says the unique aspect of this study is that the results were independent of weight loss.
The study participants were fed exactly the amount of food required to maintain their body weight, and the researchers took into account any minor fluctuations in body weight during analyses. Thus, results from this study suggest that those trying to minimize risk for diabetes over the long term might consider limiting their daily consumption of fat at around 27 percent of their diet.
"People find it hard to lose weight," said Gower. "What is important about our study is that the results suggest that attention to diet quality, not quantity, can make a difference in risk for type 2 diabetes."
The findings were even stronger in African-Americans, a population with an elevated risk for diabetes. Gower says African-Americans on the lower fat diet showed a stronger difference in insulin secretion compared to the lower carb group, indicating that diet might be an important variable for controlling diabetes risk in that population.
Study participants in the lower fat group received a diet comprising 27 percent fat and 55 percent carbohydrate. The lower carb group's diet was 39 percent fat and 43 percent carbohydrate. All food for the eight-week trial was provided by the study.
"The diets used in this study were actually fairly moderate," said UAB dietitian Laura Lee Goree, R.D., L.D., a study co-author. "Individuals at risk for diabetes easily could adopt the lower fat diet we employed. Our findings indicate that the lower-fat diet might reduce the risk of diabetes or slow the progression of the disease."
A typical dinner meal on the lower fat diet would include sesame chicken with rice, snow peas and carrots, frozen broccoli, fat-free cheese, oranges and a dinner roll.
Gower says further research is needed to determine if the difference between diets in carbohydrate or fat was responsible for the differences in the measures of glucose metabolism and probe the potential cause-and-effect relationship between insulin and glucose responses to the diets.
Published online May 18, 2011, by the American Journal of Clinical Nutrition
In this study, 69 healthy, overweight people who did not have diabetes -- but were at risk for it -- were placed on diets with modest reductions in either fat or carbohydrate for eight weeks.
Barbara Gower, Ph.D., professor in the Department of Nutrition Sciences at University of Alabama at Birmingham and lead author of the study noted that, "At eight weeks, the group on the lower fat diet had significantly higher insulin secretion and better glucose tolerance and tended to have higher insulin sensitivity." "These improvements indicate a decreased risk for diabetes."
Gower says the unique aspect of this study is that the results were independent of weight loss.
The study participants were fed exactly the amount of food required to maintain their body weight, and the researchers took into account any minor fluctuations in body weight during analyses. Thus, results from this study suggest that those trying to minimize risk for diabetes over the long term might consider limiting their daily consumption of fat at around 27 percent of their diet.
"People find it hard to lose weight," said Gower. "What is important about our study is that the results suggest that attention to diet quality, not quantity, can make a difference in risk for type 2 diabetes."
The findings were even stronger in African-Americans, a population with an elevated risk for diabetes. Gower says African-Americans on the lower fat diet showed a stronger difference in insulin secretion compared to the lower carb group, indicating that diet might be an important variable for controlling diabetes risk in that population.
Study participants in the lower fat group received a diet comprising 27 percent fat and 55 percent carbohydrate. The lower carb group's diet was 39 percent fat and 43 percent carbohydrate. All food for the eight-week trial was provided by the study.
"The diets used in this study were actually fairly moderate," said UAB dietitian Laura Lee Goree, R.D., L.D., a study co-author. "Individuals at risk for diabetes easily could adopt the lower fat diet we employed. Our findings indicate that the lower-fat diet might reduce the risk of diabetes or slow the progression of the disease."
A typical dinner meal on the lower fat diet would include sesame chicken with rice, snow peas and carrots, frozen broccoli, fat-free cheese, oranges and a dinner roll.
Gower says further research is needed to determine if the difference between diets in carbohydrate or fat was responsible for the differences in the measures of glucose metabolism and probe the potential cause-and-effect relationship between insulin and glucose responses to the diets.
Published online May 18, 2011, by the American Journal of Clinical Nutrition
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