RESUMO
We have previously demonstrated an abnormally delayed mean brake response time and an increased frequency of abnormally delayed brake responses in a group of neuropathic diabetic drivers compared with a control group of drivers with neither diabetes nor lower extremity neuropathy. The objective of the present case-control study was to compare the mean brake response time between neuropathic diabetic drivers with and without specific diabetic foot pathology. The braking performances of the participants were evaluated using a computerized driving simulator with specific measurement of the mean brake response time and the frequency of abnormally delayed brake responses. We analyzed a control group of 20 active drivers with type 2 diabetes, lower extremity neuropathy, and no history of diabetic foot pathology and an experimental group of 20 active drivers with type 2 diabetes, lower extremity neuropathy, and a history of diabetic foot pathology (ulceration, amputation, and/or Charcot neuroarthropathy) from an urban U.S. podiatric medical clinic. Neuropathic diabetic drivers without a history of specific foot pathology demonstrated an 11.11% slower mean brake response time (0.790 ± 0.223 versus 0.711 ± 0.135 second; p < .001), with abnormally delayed reactions occurring at a similar frequency (58.13% versus 48.13%; p = .0927). Both groups demonstrated a mean brake response time slower than a suggested threshold of 0.70 second. The results of the present investigation provide evidence that diabetic patients across a spectrum of lower extremity sensorimotor neuropathy and foot pathology demonstrate abnormal automobile brake responses and might be at risk of impaired driving function.
Assuntos
Condução de Veículo , Pé Diabético/fisiopatologia , Neuropatias Diabéticas/fisiopatologia , Extremidade Inferior/fisiopatologia , Tempo de Reação/fisiologia , Adulto , Idoso , Estudos de Casos e Controles , Simulação por Computador , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , SegurançaRESUMO
We have previously demonstrated an abnormally delayed mean brake response time and an increased frequency of abnormally delayed brake responses in a group of neuropathic drivers with diabetes compared with a control group of drivers with neither diabetes nor lower extremity neuropathy. The objective of the present case-control study was to compare the mean brake response time between 2 groups of drivers with diabetes with and without lower extremity sensorimotor neuropathy. The braking performances of the participants were evaluated using a computerized driving simulator with specific measurement of the mean brake response time and the frequency of the abnormally delayed brake responses. We compared a control group of 25 active drivers with type 2 diabetes without lower extremity neuropathy and an experimental group of 25 active drivers with type 2 diabetes and lower extremity neuropathy from an urban U.S. podiatric medical clinic. The experimental group demonstrated an 11.49% slower mean brake response time (0.757 ± 0.180 versus 0.679 ± 0.120 second; p < .001), with abnormally delayed reactions occurring at a greater frequency (57.5% versus 35.0%; p < .001). Independent of a comparative statistical analysis, diabetic drivers with neuropathy demonstrated a mean brake response time slower than a suggested safety threshold of 0.70 second, and diabetic drivers without neuropathy demonstrated a mean brake response time faster than this threshold. The results of the present investigation provide evidence that the specific onset of lower extremity sensorimotor neuropathy associated with diabetes appears to impart a negative effect on automobile brake responses.
Assuntos
Condução de Veículo , Neuropatias Diabéticas/fisiopatologia , Extremidade Inferior/fisiopatologia , Tempo de Reação/fisiologia , Adulto , Idoso , Estudos de Casos e Controles , Simulação por Computador , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Hemoglobinas Glicadas/análise , Humanos , Masculino , Pessoa de Meia-Idade , SegurançaRESUMO
The objective of the present investigation was to evaluate the published scientific data with respect to the diabetic foot. We specifically aimed to assess the quantity published and the specific location of the published reports. A standard PubMed(®) search was performed, and the returned abstracts were evaluated by a 2-person panel for their relevance to medical professionals working within the field of diabetic foot disease. We identified 1286 relevant studies published in 659 different journals in 2012. We also found a 6.94-fold increase in returned abstracts meeting our search criteria from January 1988 to December 2012. The results of our investigation provide unique information regarding the high volume and variety of published information pertaining to diabetic foot disease and perhaps highlights a need for multidisciplinary thinking with respect to publishing and data organization, in addition to patient care.
Assuntos
Bibliometria , Pé Diabético , Pé Diabético/prevenção & controle , Humanos , PubMedRESUMO
A potentially underappreciated member of the multidisciplinary approach to diabetic limb salvage is that of psychiatry. Diabetic patients are more likely to experience depression, and diabetic patients with depression are more likely to undergo an amputation. Also, both diabetes and depression independently increase the healthcare costs in the United States. The objective of the present investigation was to increase knowledge among diabetic foot practitioners with respect to psychiatric and other mental health patient-care issues, specifically the potential application of the 5 stages of grief to diabetic limb loss and amputation. We enlisted the assistance of a clinical professor from the psychiatry department at our institution to review the 5 stages of grief, provide context specific for application to diabetic limb loss, and offer clinically relevant guidelines for surgeons to better understand and communicate with their patients at each stage. The 5 stages reviewed were denial, anger, bargaining, depression, and acceptance. We hope that the present review will increase the body of knowledge with respect to relevant psychiatric issues and the diabetic foot and provide a starting point for increased awareness with respect to this important, yet underappreciated, aspect of patient care.