RESUMEN
AIMS/HYPOTHESIS: To re-evaluate the use of Granulocyte-Colony Stimulating Factor (G-CSF) in the treatment of infected diabetic foot ulcers. METHODS: Thirty-seven diabetic subjects were randomised to Granulocyte-Colony Stimulating Factor (G-CSF) (n=20) or placebo (n=17). The primary endpoint was resolution of cellulitis, which was evaluated clinically and with an infection summary score. Patients were hospitalised for 10 days and received subcutaneously either 5 microg/kg G-CSF or placebo daily. Ulcers were treated with a standard wound protocol and the patients were instructed to stay in bed. All subjects received antibiotics (clindamycin and ciprofloxacin) intravenously until the inflammation had subsided. RESULTS: Patients who received G-CSF did not have an earlier resolution of clinically defined cellulitis (p=0.57). The infection summary score declined, but comparably, in both groups (G-CSF: 29.5+/-18.4 to 6.7+/-6.3 p<0.001, placebo: 24.2+/-16.9 to 8.9+/-7.2 p<0.001). The ulcer volume, which was not greater among placebo patients, was reduced by 59% in G-CSF and by 35% in placebo patients. CONCLUSION/INTERPRETATION: We conclude that antibiotic and non weight-bearing therapy (bed rest) accelerated the resolution of cellulitis in infected foot ulcers. Additional treatment with G-CSF had no further beneficial effect.
Asunto(s)
Pie Diabético/tratamiento farmacológico , Pie Diabético/microbiología , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Infecciones/complicaciones , Anciano , Antibacterianos/administración & dosificación , Antiinfecciosos/administración & dosificación , Reposo en Cama , Celulitis (Flemón)/tratamiento farmacológico , Celulitis (Flemón)/etiología , Ciprofloxacina/administración & dosificación , Clindamicina/administración & dosificación , Pie Diabético/complicaciones , Pie Diabético/terapia , Quimioterapia Combinada/uso terapéutico , Femenino , Filgrastim , Humanos , Infecciones/tratamiento farmacológico , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Proteínas Recombinantes , Resultado del TratamientoRESUMEN
The EURODIAB IDDM complications study is a multicenter clinical study for evaluation of the prevalence of microvascular, macrovascular and acute metabolic complications in randomly selected samples of insulin-dependent diabetic patients attending 31 European diabetes centers. A total of 3250 patients were studied (mean age: 32.7 +/- 10 years, mean duration of diabetes: 14.7 +/- 9.3 years) by standardized, validated methods. The third medical department of the Vienna-Lainz hospital participated from Austria. 122 patients, age: 34.9 +/- 9.9 years, duration of diabetes: 16 +/- 10 years were recruited from this center. There was a wide variation in the frequency of complications between the different European centres: Prevalence of diabetic retinopathy 25-60%; Vienna showed the lowest prevalence (25%). Metabolic control (HbA1c) ranged from 5.7-9.4%; Vienna shared the second place with two other centers (6.0%). Despite the very low HbA1c in the Viennese population, the frequency of severe hypoglycemic attacks was in the lower range, which is an extraordinary result in this study. Incipient diabetic renal disease, characterized by microalbuminuria varied in frequency between 15 and 33% (Vienna 23%). Important associations of raised blood pressure (frequency in all centers: 8-41%, Vienna: 29%) with renal disease and retinopathy have implications for the initiation of preventive measures. The data on diabetic complications obtained from the EURODIAB study permit a comparison between the different European centers and emphasize the need for implementation of the St. Vincent recommendations.
Asunto(s)
Diabetes Mellitus Tipo 1/epidemiología , Angiopatías Diabéticas/epidemiología , Adolescente , Adulto , Albuminuria/sangre , Albuminuria/diagnóstico , Albuminuria/epidemiología , Austria/epidemiología , Glucemia/metabolismo , Estudios Transversales , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/diagnóstico , Angiopatías Diabéticas/sangre , Angiopatías Diabéticas/diagnóstico , Cetoacidosis Diabética/sangre , Cetoacidosis Diabética/diagnóstico , Cetoacidosis Diabética/epidemiología , Neuropatías Diabéticas/sangre , Neuropatías Diabéticas/diagnóstico , Neuropatías Diabéticas/epidemiología , Retinopatía Diabética/sangre , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/epidemiología , Femenino , Estudios de Seguimiento , Hemoglobina Glucada/metabolismo , Humanos , Hipoglucemia/sangre , Hipoglucemia/diagnóstico , Hipoglucemia/epidemiología , Incidencia , Masculino , Persona de Mediana EdadRESUMEN
A new method known as pedography enables the measurement of plantar pressure while walking. Different areas on the sole can be separately analyzed by means of a personal computer. We studied plantar pressure in 20 patients walking normally on a horizontal platform. Four different stages of weight bearing were investigated, namely 0, 10, 20, and 30 kg, in the ten diabetics and ten non-diabetics. All diabetic suffered from peripheral neuropathy, which was clinically proven as well as a reduction in nerve conduction velocity in the peroneal nerve. Non-diabetics showed no abnormal clinical findings on the lower extremities and nerve conduction velocity was within the normal range. The mean age and size differed between the diabetics and non-diabetics 52 +/- 5 versus 37 +/- 7 and 178 +/- 5 versus 185 +/- 4. Body weight was equal (84 +/- 6 versus 85 +/- 5 kg). We found no significant difference in maximum pressure on the heel, though there were differences on the fore-foot. Diabetics showed a higher maximum pressure already without weight bearing and reached a plateau at the 10 kg level, which was not exceeded at the higher stages of weight bearing. In summary, diabetic patients with neuropathy are subjected to very high plantar pressures at relatively low stages of weight bearing. Pedography enables preventive measures to be undertaken in time, e.g. prescription of orthopaedic insoles.