From the Guidelines
To maintain optimal health and prevent complications, individuals with diabetes should prioritize proper foot care, including daily washing and drying, moisturizing, and examining their feet for any signs of ulcers or damage, as recommended by the International Working Group on the Diabetic Foot (IWGDF) guidelines 1. When it comes to feet and hands, it's essential to consider the unique challenges faced by individuals with diabetes, who are at a higher risk of developing foot ulcers and other complications. The IWGDF guidelines provide a comprehensive framework for preventing foot ulcers in persons with diabetes, emphasizing the importance of regular screening, education, and proper foot care 1. Some key recommendations for foot care include:
- Screening individuals with diabetes annually for signs or symptoms of peripheral neuropathy and peripheral artery disease (PAD) to determine their risk of foot ulceration 1
- Educating individuals with diabetes on how to protect their feet, including not walking barefoot or in thin-soled slippers, and washing their feet daily with careful drying 1
- Encouraging individuals with diabetes to examine their feet daily and seek medical attention if they notice any signs of ulcers or damage 1
- Providing structured education on foot self-care and considering coaching on self-monitoring foot skin temperatures to identify early signs of foot inflammation 1 In terms of hands, while the guidelines do not specifically address hand care, it's still important for individuals with diabetes to prioritize proper hand hygiene and moisturizing to prevent dryness and irritation. Additionally, individuals with diabetes should be aware of the potential risks of nerve damage and peripheral neuropathy, which can affect both the hands and feet 1. Overall, by prioritizing proper foot care and following the IWGDF guidelines, individuals with diabetes can reduce their risk of developing foot ulcers and other complications, and maintain optimal health and quality of life. The most critical step is to educate individuals with diabetes on proper foot care and encourage them to take an active role in monitoring their foot health, as recommended by the IWGDF guidelines 1.
From the Research
Feet and Hands in Diabetic Patients
- Diabetic patients often experience peripheral neuropathy, which can cause pain, numbness, and tingling in the feet and hands 2, 3.
- The symptoms of peripheral neuropathy typically follow a stocking-glove pattern, progressing proximally from the feet and hands 2.
- Diabetic foot infection is a common complication, usually resulting from disruption of the skin barrier, trauma, pressure, or ischemic wounds 4.
Diagnostic Challenges
- Diagnosing diabetic neuropathy can be challenging, particularly in patients with early and mild neuropathy, and there is currently no single established diagnostic gold standard 3.
- A hierarchical system combining symptoms, signs, and confirmatory tests is often used in research, but the best paradigm for screening remains uncertain 3.
Treatment and Management
- Treatment for painful diabetic peripheral neuropathy typically involves medications such as pregabalin, duloxetine, and gabapentin, as well as lifestyle modifications and management of blood sugar levels 2, 3.
- Improved glycaemic control is more effective in type 1 than in type 2 diabetes, and only symptomatic management is available for painful diabetic neuropathy 3.
- Detailed sensory profiles may help identify responsive patients to specific treatments and lead to tailored treatment for patient subgroups with painful diabetic neuropathy 3.