Diabetes - save a leg, save a life

Excerpt from thechart.blogs.cnn.com
Dr. Sanjay Gupta examines America's diabetes epidemic and how can we as a nation can fight this potentially deadly disease.
Each year in the U.S. diabetes results in the amputation of about 65,700 legs or feet. About 85% of those began with a diabetic foot ulcer. And for Dr. David Schwegman, the mission to educate people about the issue is personal.

His father, a diabetic, had a foot ulcer that resulted in the amputation of his left leg, which contributed to his death, his son said.
"He became a statistic," Schwegman said. "He was one of the 50% of people that died within five years after having an amputation."
Diabetic foot ulcers, or DFUs, are usually located on the ball of the foot, the bottom of the big toe or sides of the feet. They can be a result of neuropathy, or nerve damage which leads to a loss of feeling.

Although prevention is key, simply not treating an ulcer can lead to infection, particularly in the bone, and eventual loss of a limb.

"If you have a DFU that leads to a major amputation, your risk of death in five years is greater is higher than that of breast cancer and prostate cancer combined," Schwegman said.

Right now, 18.8 million adults and children in the U.S. have diabetes. The Centers for Disease Control and Prevention estimates that 7 million people have undiagnosed diabetes and 79 million are prediabetic.

Diabetics need to know that treating the ulcer early is the best way to get it healed.
"If we're not treating them aggressively, the chances that they heal is actually very, very low," Schwegman said.
An important part of the evaluation of a person with a diabetic foot ulcer is a thorough vascular exam, since diabetics have a higher risk of having peripheral arterial disease. The condition results when circulation to the legs and feet is blocked or narrowed by calcifications. The poor blood flow can cause pain and discoloration in the feet- an increase in a red color, a dusky bluish color or sometimes the toes turn black and result in amputation.
Dr. Desmond Bell, a wound care specialist, recommends going straight to a podiatrist or wound care specialist if a cut, sore or wound does not heal in a week or two. Those with a history of diabetic foot ulcers should see a specialist immediately.
Bell said several newer treatments are available to treat these wounds. None are a "silver bullet" for every single wound.
Of the thousands of products available, only these three have evidence that they have increased wound hea ling rates:
-Advanced skin cell substitutes include Dermagraft and Apligraf. These are similar in that they are derived from neonatal foreskins.
-A growth factor gel, Regranex.
Hyperbaric oxygen therapy can also heal wounds and treat infections.
Most exciting, Bell said, is peripheral revascularization, in which cardiologists and others, go into the groin similar to an angioplasty for the heart. Through this new procedure, doctors can open up blockages in the leg and restore blood flow.
"It requires lots of doctors often times & it requires a motivated patient," Schwegman said. "By saving their leg, it really does save their life."                                                                    
          Georgiann Caruso - CNN Medical Associate Producer

Excerpt from dermagraft.com
Diabetic foot ulcers (DFUs) are chronic wounds that can develop on the foot or lower extremities of people with diabetes. Poor healing of DFUs may be due to several factors, including abnormal cellular/inflammatory pathways, peripheral neuropathy and vascular disease/tissue hypoxia.1 Among people with diabetes, approximately 15 to 25% experience a DFU in their lifetime 2,3 and approximately 2% develop a DFU each year.
If not properly treated, DFUs can result in serious complications, including amputation. In fact, of those patients who do develop a DFU, 14% to 24% will require an amputation.1 In the United States, approximately 60% of all nontraumatic lower extremity amputations occur among persons with diabetes; of these amputations, approximately 85% are preceded by a foot ulcer. Patients hospitalized with diabetes are 28 times more likely to have an amputation than patients without diabetes.
"Any wound that remains unhealed after 4 weeks is cause for concern, as it is associated with worse outcomes, including amputation."

Dermagraft has helped to heal the wounds of more than 50,000 patients with diabetic foot ulcers.
Dermagraft is manufactured from human fibroblast cells derived from newborn foreskin tissue. During the manufacturing process, the human fibroblasts are seeded onto a bioabsorbable polyglactin mesh scaffold. The fibroblasts proliferate to fill the interstices of this scaffold and secrete human dermal collagen, matrix proteins, growth factors, and cytokines to create a three-dimensional human dermal substitute containing metabolically active, living cells. Dermagraft provides a combination of living fibroblasts, matrix proteins, and bound factors that protect the wound and stimulate dynamic events that promote regeneration and repair.
The earlier you start treating a wound with Dermagraft, the better your patient's chances for a full recovery. Dermagraft is supplied frozen in a clear bag containing one piece of approximately 2” x 3” for a single-use application. One application of Dermagraft each week has been proven most effective. After Dermagraft is applied, it is important for patients to keep their weight off their foot as much as possible to give the wound a chance to heal.                                                          
         © 2010 Advanced Biohealing, Inc.

Why have I decided to go on and on about this subject?? Watching the healing that Dermagraft has brought to patients is why. These pictures represent healing that took place with the help of Dermagraft over just 9 weeks. Amazing, simply amazing. Get the word out ... Healing is key, the faster the better.   

Diabetes does not have to be a death sentence. Control is key. Control your blood sugars. Know your numbers. Less damage to your body, better healing happens when your blood sugar is better controlled. Strive for a goal Hemoglobin A1C of 6.5. Regular checkups. If you have family history of diabetes, but you have not been diagnosed - eat right, exercise, and get regular checkups. Just because you have been checked once and came up negative for diabetes doesn't mean you can ignore the risk. For those already diagnosed with diabetes, take care of your feet - watch for callouses or sores. If you have a callous, get it taken care of. Callouses may hide an underlying ulcer. After bathing, make sure you dry between your toes to prevent athletes foot which can turn into an ulcer. On the opposite end of the spectrum, don't let your feet get overly dry - use a good moisturizer to prevent cracks, especially on your heels. Don't go barefoot, wear supportive shoes, tight shoes. If you do end up with a sore or blister, get it taken care of immediately so it doesn't become worse and lead to a big ulcer or even amputation of your toe or foot. If this doesn't apply to you, but you know someone that it does, please pass on the information.