The Evolution of Diabetic Foot Disease Over the Past Generation
Diabetes-related foot complications have long been a significant health concern, but recent research from our friends and colleagues– international experts Marco Meloni, Alberto Piaggesi, and Luigi Uccioli offers new insights into the evolution of diabetic foot disease (DFD) over the past two decades. Their comprehensive review, published in The International Journal of Lower Extremity Wounds, provides a detailed analysis of the changing landscape of DFD and its implications for treatment and patient care.
The Changing Face of Diabetic Foot Disease
The study, titled “From a Spark to a Flame: The Evolution of Diabetic Foot Disease in the Last Two Decades,” highlights a shift in the characteristics of DFD. There has been an increase in ischemic and neuro-ischemic foot cases compared to purely neuropathic ones. This evolution is accompanied by a rise in cardiovascular comorbidities, which contribute to the fragility of patients with diabetic foot syndrome (DFS).
Peripheral arterial disease (PAD) in diabetic patients presents more aggressively, often affecting distal regions that are challenging to treat. The authors emphasize that untreatable PAD is a significant unmet need for clinicians and a primary risk factor for major amputation in patients with diabetic foot ulcers (DFUs).
Key Findings and Implications for Treatment
Meloni, Piaggesi, and Uccioli’s review documents the evolution of DFD patient characteristics, noting an increased rate of PAD and associated cardiovascular risk factors. The study underscores the importance of foot revascularization in limb salvage, especially in the presence of below-the-ankle arterial disease.
The authors also address the issue of “no-option critical limb ischemia” (NO-CLI), where mechanical revascularization is not feasible. They discuss promising results from autologous cell therapy using peripheral blood mononuclear cells (PB-MNCs) and the benefits of anticoagulation therapy with low-dose rivaroxaban in addition to antiplatelet therapy.
Conclusion and Future Directions
Despite advancements, DFD remains a condition leading to hospitalization, amputation, and mortality. The review concludes that while a portion of ischemic patients remains untreatable by conventional revascularization, emerging therapies like autologous cell therapy and dual pathway inhibition may change the prognosis for these no-option patients in the future.
Acknowledgments and Author Contributions
The authors have made substantial contributions to the design of the work, with Meloni drafting the article and Piaggesi and Uccioli providing critical revisions. They declare no conflicts of interest and received no financial support for the research, authorship, or publication of the article.
For those interested in delving deeper into this significant research, the full article can be accessed through its DOI: 10.1177/15347346241238480.
Citations: DOI: 10.1177/15347346241238480
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