«The diabetes mellitus is a disease that affects 6-8% of the population. Those with unregulated diabetes are at risk of developing ulcers on their feet, i.e. open sores. It is a complication that occurs in 15% of patients and becomes a cause of amputation in 25-50% of those who are called upon to treat it. According to figures, every 30 seconds such an operation is performed worldwide, reaching approximately 1,000,000 per year. In America, 70,000 amputations are performed every year, while in Greece the rate is proportionally high, since the number can reach 3,000,» says Dermatologist - Aphrodisiologist Dr. Christos Stamos.
«This is an unfavourable development that significantly degrades the quality of life of patients, who require increased care, prolonged hospitalisation and frequent visits to doctors, places a financial burden on both the patients themselves and the health systems, while a large number of patients eventually lose their lives within five years after amputation. This mortality rate is higher than for most cancers. Given the global increase in diabetic patients due to lifestyle and obesity, finding the causes that lead to ulcer healing could protect many from amputation of one or both legs, giving them many quality years of life,» he adds.
However, the pathogenesis of diabetic ulcers is not fully understood. Reduced wound healing leading to the development of chronic wounds in diabetic patients is manifested exclusively in the foot. Several cell types, including endothelial cells, fibroblasts, keratinocytes and immune cells, play an important role in the wound healing process, but little is understood about their involvement in wound healing.
The researchers analyzed the cellular differences present in the diabetic ulcers of patients who heal and those who do not heal and go on to develop chronic ulcers, the cellular differences between patients with diabetes and healthy individuals without diabetes, and the differences between the foot with a diabetic ulcer and intact forearm skin in both patients with diabetes and healthy individuals.
According to their findings, specific fibroblast subtypes play a key role in the healing of these ulcers and targeting these cells could be a therapeutic option. They clarified, however, that while further research is needed, the dataset will be valuable material for diabetes research, dermatology and wound healing and can serve as a basis for designing experiments to evaluate therapeutic interventions.
«These ulcers often arise in diabetic individuals who have two or more risk factors at the same time, with diabetic peripheral neuropathy and peripheral arterial disease usually playing a central role», explains Dr Stamos.
Prevention is the cornerstone of avoiding their creation. There are four tips that, if implemented, significantly reduce the chances. Specifically:
1. Make regular visits to the doctor to identify the foot at risk in time, as the absence of symptoms in a person with diabetes does not rule out the disease. The examination should include, inter alia, the assessment of skin colour, temperature, the presence of callus or oedema and pre-ulceration signs. Also, checking for poor foot hygiene, e.g. incorrectly trimmed toenails, and the presence of a superficial fungal infection.
2. Wear appropriate shoes, since wearing narrow or small shoes and walking without them are the main causes of foot injuries leading to ulcers. People who have loss of sensation in their feet should wear the appropriate shoes for them at all times, both indoors and outdoors. All footwear should accommodate any change in foot structure or foot biomechanics.
3. Address the factors that could lead to the development of the ulcer. This includes: removing the abundant callus, protecting against or caring for blisters, properly treating ingrown or ingrown nails and prescribing treatment for fungal infections. Such treatment should be repeated until complete remission.
4. Get informed. It has been found that improving the patient's knowledge of foot care and self-care behaviour, as well as enhancing motivation, facilitates adherence to a behaviour that can be preventive. People with diabetes should learn how to recognise foot ulcers and the signs that precede their appearance and know the steps to take if problems arise.
