Structured health care for subjects with diabetic foot ulcers results in a reduction of major amputation rates

OBJECTIVE: We tested the effects of structured health care for the diabetic foot in one region in Germany aiming to reduce the number of major amputations. RESEARCH DESIGN AND METHODS: In a prospective study we investigated patients with diabetic foot in a structured system of outpatient, in-patient and rehabilitative treatment. Subjects were recruited between January 1(st), 2000 and December 31, 2007. All participants underwent a two-year follow-up. The modified University of Texas Wound Classification System (UT) was the basis for documentation and data analysis. We evaluated numbers of major amputations, rates of ulcer healing and mortality. In order to compare the effect of the structured health care program with usual care in patients with diabetic foot we evaluated the same parameters at another regional hospital without interdisciplinary care of diabetic foot (controls). RESULTS: 684 patients with diabetic foot and 508 controls were investigated. At discharge from hospital 28.3% (structured health care program, SHC) vs. 23.0% (controls) of all ulcers had healed completely. 51.5% (SHC) vs. 49.8% (controls) were in UT grade 1. Major amputations were performed in 32 subjects of the structured health care program group (4.7%) vs. 110 (21.7%) in controls (p<0.0001). Mortality during hospitalization was 2.5% (SHC) vs. 9.4% in controls (p<0.001). CONCLUSIONS: With the structured health care program we achieved a significant reduction of major amputation rates by more than 75% as compared to standard care

Selen in der Intensivmedizin

Mit der Entdeckung des Selens als essentielles Spurenelement und der Glutathionperoxidase als Selenoenzym sowie der Tatsache, daû Selenmangel relativ weit verbreitet ist, wurde erstmals ein Zusammenhang zu einigen schweren Erkrankungen hergestellt (Keshan-Krankheit, Kaschin-Beck-Syndrom). Interessant ist dabei, daû sich trotz dieser und anderer bekannter Selenmangelerkrankungen eine Therapie in der Humanmedizin nur langsam zu etablieren beginnt, waÈ hrend die Selensupplementation in der VeterinaÈ rmedizin bereits Standard ist. Die Autoren beschaÈ ftigen sich seit 1990 mit der Rolle des Spurenelements Selen bei septischen Krankheitsbildern in der Intensivmedizin, beim ReperfusionsphaÈnomen nach gefaÈûchirurgischen Eingriffen und in der Onkologie. Sie konnten zeigen, daû die adjuvante Therapie der akuten Pankreatitis und der Sepsis mit Natriumselenit einen positiven Effekt auf das Outcome der Patienten zu haben scheint (eine multizentrische, doppelblinde, randomisierte Sepsisstudie zur Validierung dieser Ergebnisse ist in Vorbereitung). Neue Erkenntnisse zur Beeinflussung von Transkriptionsfaktoren durch Selen bei systemischem Inflammationssyndrom und Sepsis erlauben eine wissenschaftlich fundierte Interpretation der klinischen Ergebnisse. Weitere molekularbiologische Untersuchungen werden das Spurenelement Selen zu einem der interessantesten Forschungsprojekte der naÈ chsten 10 Jahre in Intensivmedizin und Onkologie machen.Since selenium was discovered as an essential trace element being widely distributed, and since glutathione peroxidase is known as a selenoenzyme, associations with several severe diseases were established (Keshan disease, Kaschin-Beck syndrome). Despite these known selenium deficiency diseases a related human therapy is still not established so far. In veterinary medicine, however, substitution of selenium is already a standard therapy. Our laboratory investigates the role of selenium since 1990. This includes investigations about the effects of selenium in acute inflammatory diseases in intensive care, in the reperfusion phenomenon following vascular surgery, and in oncology. In acute pancreatitis and sepsis, adjuvant therapy using sodium selenite seems to have positive effects on the overall outcome of patients (a multicenter, double-blind, randomized trial on sepsis is being prepared). New findings concerning the influence of selenium on transcription factors in inflammatory processes will permit a scientifically sound interpretation of clinical results. With further investigations in molecular biology the trace element selenium will become, in the next decade, one of the most interesting topics in intensive care and oncology.Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich