Diabetic patients and how to encourage prosthetic care
November is National Diabetes Month. This movement hopes to raise awareness of symptoms, promote healthy living and ensure people are aware of risk factors. At Adapttech we'd like to partake in the initiative and raise awareness of this issue.
Diabetic complications in the lower extremity are associated with significant morbidity and mortality and impact heavily upon the public health system. Increased life expectancies have contributed significantly to this exponential rise, with diabetes now contributing to 9% of global mortality, equating to 4 million deaths per year [1, 2]. Overall, about 200,000 people in the United States have amputations each year, and about 130,000 of those people have diabetes. There’s also an epidemic of diabetes, which affects about 34 million U.S. adults. The CDC estimates that one in three American adults will have diabetes by the year 2050 [3].
Early and accurate recognition of these abnormalities is crucial, enabling the early initiation of treatments and thus avoiding or minimizing deformity, dysfunction, and amputation [4]. Despite the previous alerts to the importance of early detection and management, prevention practices remain poor, with inconsistent patient follow-up and management compliance [5,6]. As a result, subjects with diabetic foot ulcers maintain poorer quality of life, with a higher baseline depression rate, and 5-year mortality rates of up to 74% [7].
The healing of the residual limb must be already in process for prosthetic intervention to be successful. Generally speaking, pre-prosthetic care is essential and, if undertaken correctly, can assure the patient of an optimal chance of ambulating again.8 However, diabetic complications are common and diverse; these complications result from complex interactions between diabetic vasculopathy, neuropathy, structural deformity, and decreased immunity [4]. Prosthetic limbs for individuals with diabetes are designed, fitted, and maintained differently than prosthetic limbs for people who aren't living with diabetes.
To keep assuring the patients’ optimal chance of ambulating, the prosthetist must remind the patient to care for the prosthesis, prevent water damage to the prosthesis, and store it properly.
By keeping the prosthesis clean and dry, the patient will prevent the build-up of sweat, dirt, and bacteria. Diabetics are five times more predisposed to wound infection than patients without diabetes mellitus. The amputated stump frequently becomes infected due to inadequate blood circulation, a weak immune system, and poorly controlled diabetes mellitus. Pain, stump Edema, and osteomyelitis are significant complications associated with lower limb amputation wounds. If the prosthesis isn’t cleaned properly, there will be a higher chance for infection wounds.
Here is other advice for improving diabetic amputees' quality of life:
Remove the prosthesis before going to bed. Examine the device for loose parts or damage. Examine the stump for blisters or other signs of irritation.
Clean and put a small amount of lotion on the stump and massage the skin.
Place a bandage on the stump to decrease swelling when the patient is not wearing the prosthesis.
Regularly inspect the skin of the stump to look for sores or wounds. The patient may need to have someone else to help look or use a mirror.
Practice exercises recommended by the physical therapist. These will include exercises for stretching, range of motion, body positioning, and endurance.
Wear proper-fitting shoes and never change the height of the heels. The prosthesis is designed for one heel height only (yet!).
Clean the prosthesis' socket with soap and water.
Maintain a healthy lifestyle and avoid weight fluctuation (this will help to keep the proper prosthesis fit).
References
[1] J. E. Shaw, R. A. Sicree, and P. Z. Zimmet, “Global estimates of the prevalence of diabetes for 2010 and 2030,” Diabetes Research and Clinical Practice, vol. 87, no. 1, pp. 4–14, 2010.
[2] D. R. Whiting, L. Guariguata, C. Weil, and J. Shaw, “IDF Diabetes Atlas: global estimates of the prevalence of diabetes for 2011 and 2030,” Diabetes Research and Clinical Practice, vol. 94, no. 3, pp. 311–321, 2011.
[3] Reducing Disparities in Diabetic Amputations. (2021, April 21). National Institute of Diabetes and Digestive and Kidney Diseases.
[4] Naidoo, P., Liu, V. J., Mautone, M., & Bergin, S. (2015). Lower limb complications of diabetes mellitus: a comprehensive review with clinicopathological insights from a dedicated high-risk diabetic foot multidisciplinary team. The British journal of radiology, 88(1053), 20150135. https://doi.org/10.1259/bjr.20150135
[5]. J. van Netten, P. E. Price, L. A. Lavery et al., “Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review,” Diabetes/Metabolism Research and Reviews, vol. 32, supplement 1, pp. 84–98, 2016.
[6] W. Clayton Jr. and T. A. Elasy, “A review of the pathophysiology, classification, and treatment of foot ulcers in diabetic patients,” Clinical Diabetes, vol. 27, no. 2, pp. 52–58, 2009.
[7] V. Fejfarov ́a, A. Jirkovsk ́a, E. Dragomireck ́a et al., “Does the diabetic foot have a significant impact on selected psychological or social characteristics of patients with diabetes mellitus?” Journal of Diabetes Research, vol. 2014, Article ID 371938, 7 pages, 2014
[8] Lange, L. R. (1982). Prosthetic Implications With The Diabetic Patient. O&P Virtual Library. Retrieved November 23, 2021, from http://www.oandplibrary.org/op/1982_02_096.asp
