Overview of Motor Nerve Damage in People with Diabetes Mellitus

Damage to motor nerves in people with diabetes increases the risk of a foot injury. This occurs because the damage results in changes in foot biomechanics, muscle atrophy, deformity, and increased pressure on the feet. So far, the examination of motor nerve damage in people with diabetes in agricultural areas such as the Jember Regency is still rarely touched by primary health services. The purpose of this study was to identify motor nerve damage in people with diabetes in the agriculture area of ​​the Jember Regency. This type of research is exploratory, descriptive, 102 respondents obtained by purposive sampling technique. Inclusion criteria in this study are age> 18 years; do not have DFU active, and did not experience amputation in both legs. Data collection uses instrument modification from MNSI (Michigan Neuropathy Screening Instrument) and MDNS (Michigan Diabetic Neuropathy Score). MNSI using in inspecting for deformity, while MDNS using for forms of physiological reflex damage and muscle strength. The analysis used in univariate and displayed in the frequency distribution. The results showed that the majority of respondents who suffer from DM are experienced in the middle adulthood category (71.6%), with a length of suffering more than five years (95.1%), and have a history of comorbidities (68.6%). The most common form of motor deformity damage was hallux valgus on the right and left legs (38.2%; 26.4%). Forms of motor damage in the form of muscle strength, severe damage to the abduction of the right and left legs (7.8%), and were found right or left toe extensions (1.9%; 2.9%). Motor damage in the form of no physiological reflexes was found in the right and left Quadriceps femoral (2%; 1%), and right or left leg Achilles (1%). The result of total motor damage assessment is that people with diabetes have decreased muscle strength in the right and left extremities (74.5%; 72.5%). This research shows that the majority of people with diabetes in the agricultur area of ​​the Jember Regency suffer motor nerve damage. Therefore, there is a need for preventive measures to prevent the worsening condition of people with diabetes.

The Axial Impact Response and Plantar Load Distribution of the Hybrid III and MIL-Lx Under Altered Ankle Postures

Foot injuries as a result of automotive collisions are frequent and impactful. Anthropomorphic Test Devices (ATDs), used to assess injury risk during impact scenarios such as motor vehicle collisions, typically assess risk of foot/ankle injuries by analyzing data in tibia load cells. The peak axial force (Fz) and the Tibia Index (TI) are metrics commonly used to evaluate risk of injury to the lower extremity but do not directly account for injury risk to the foot, or the risk of injury associated with out-of-position loading. Two ATDs, the Hybrid III lower leg and the Military Lower Extremity (MIL-Lx), were exposed to axial impacts at seven different ankle postures. An array of piezoresistive sensors located on the insole of a boot was employed during these tests to assess the load distribution variations among postures and between ATD models on the plantar surface of the foot. Both posture and ATD model affected the load distribution on the foot, highlighting the need for regional injury risk assessments in this vulnerable anatomical region. The increase in forefoot loading during plantarflexion was not reflected in the standard industry metrics of Fz or TI, suggesting that increased fracture risk to the forefoot would not be detected. The variations in load distribution between the models could also alter injury risk assessment in frontal collisions based on differences in attenuation. These data could be used for regional foot injury assessment and to inform the design of an improved ATD foot.

Evaluation of Real-World Smart Sock-Based Temperature Monitoring Data as a Physiological Indicator of Early Diabetic Foot Injury: Case-Control Study (Preprint)

BACKGROUND Diabetic foot ulcers represent major health care complications both in terms of cost and impact to quality of life for patients with diabetic peripheral neuropathy. Temperature monitoring has been shown in previous studies to provide a useful signal of inflammation that may indicate the early presence of a foot injury. OBJECTIVE In this study we evaluated the temperature data for patients that presented with a diabetic foot injury while utilizing a sock-based remote temperature monitoring device. METHODS The study abstracted data from patients enrolled in a remote temperature monitoring program in year 2020-2021 using a smart sock (Siren Care, San Francisco, California, USA). In the study cohort, a total of 5 participants with a diabetes-related lower extremity injury during study period were identified. In the second comparison cohort, a total of 26 patients met the criteria for monitoring by the same methods that did not present with a diabetes-related podiatric injury during the same period. The 15-day temperature differential between six defined locations on each foot was the primary outcome measure among subjects who presented a diagnosed foot injury. Paired t-tests were used to compare the differences between the two groups. RESULTS A significant difference in temperature differential was observed in the group that presented with a podiatric injury over the course of evaluation vs. the comparator group that did not present with a podiatric injury with temperature measured in °F. The average difference from all six measured points was 1.4°F between the injury group (mean 3.6 +/- 3.0) and the comparator group (mean 2.2 +/- 2.5, t=-71.4; P<.000). CONCLUSIONS The presented study demonstrated significant temperature difference for patients presenting with a foot injury in a 15-day period prior to the diagnosis of an injury compared with a similar period for patients without an injury. The findings suggest temperature monitoring may be a predictor of a developing foot injury. The continuous temperature monitoring system employed has implications for further algorithm development to enable early detection. The study was limited by a nonrandomized, observational design with limited injuries present in the study period.

TIME LOSS INJURIES AMONG FORMER COLLEGIATE GYMNASTS: THE INFLUENCE OF FEMALE ATHLETE TRIAD SYMPTOMS

Background: Female college gymnasts have one of the highest injury rates in the NCAA and are at risk for female athlete triad syndrome. While female athlete triad syndrome leads to bone stress injuries, little research has been done on specific injury location and type. Purpose: Our objective was to compare injuries sustained during gymnastics between former collegiate gymnasts who did and did not report experiencing symptoms of Female Athlete Triad Syndrome during college, including disordered eating (DE) or menstrual irregularity (MI). Methods: 465 former collegiate gymnasts completed an online survey distributed via social media. Participants were grouped based on mensural irregularity and whether they had a history of DE/ED of not. We compared injury outcomes (time-loss injuries and injuries resulting in surgery) and injury locations between groups using Chi-square analyses. Results: A significantly greater proportion of those who reported MI during college reported a time-loss wrist/hand and injury during gymnastics compared to eumenorrheic gymnasts (Table 1). A significantly greater proportion of those who reported MI during college sustained an injury that required surgery relative to those who reported regular periods during college (52% vs 65%, p=0.009). Specifically, they reported a greater proportion of hip/pelvis (2% vs. 7%, p=0.02) and leg/ankle/foot surgeries (23% vs. 33%, p=0.009). A significantly greater proportion of the group who reported DE during college reported a time-loss gymnastics injury during college that did not require surgery or retirement, relative to those who did not report DE (78% vs 66%, p= 0.005) (Table 2). Specifically, they reported a greater proportion of spine (25% vs. 14%, p=0.002), hip/pelvis (8% vs. 2%, p=0.001), and leg/ankle/foot injuries (53% vs. 41%, p=0.01). There was a significantly greater proportion of gymnasts who reported DE during college who sustained a hip/pelvis (7% vs. 3%, p=0.04) and leg/ankle/foot injury (34% vs. 23%, p=0.02) requiring surgery compared to those who did not report DE during college. onclusion: College gymnasts who experienced triad symptoms were more likely to experience a time-loss injury, or have an injury requiring surgery. Clinicians and providers should be aware of the association between injuries and DE and MI in gymnasts. Early intervention for athletes with triad symptoms should be undertaken to decrease the risk of musculoskeletal injury.

Treatment options for soft tissue defects in severe foot trauma in children

Objective: Severe foot trauma in children is a therapeutic challenge, with presence of devitalised and soiled distal tissues. Several reconstruction and covering procedures can be applied, including artificial dermis (AD), negative pressure wound therapy (NPWT), fasciocutaneous flaps and free flaps. Here, we have developed and evaluated an algorithm for treating severe foot injuries with skin defects in children Method: Paediatric cases of severe foot injury treated over a 16-year period were retrospectively reviewed. Characteristics of the injuries, surgical procedures, complications and the modified Kitaoka score (clinical and functional rating score of the ankle and foot) were recorded. Results: A total of 18 children were included. The mean age at the time of injury was four years and 10 months (range: 1–11 years). The mean follow-up period was 6.2 years. Of the children, 13 presented with an amputation (12 partial foot amputations and one whole ankle and foot). The skin defect was combined with tendon exposure in nine cases, and/or bone and cartilage in seven cases, and heel damage in two cases. A flap was implemented in eight cases, of which one failed. NPWT was used in 13 patients (for an average of 21 days) and was combined with AD in six patients. The mean modified Kitaoka score was 68 (range: 55–80). Additional surgery during the follow-up period was required in seven patients (dorsal skin retraction, a thick flap, osteoma, trophic ulcer or ankle deviation). Conclusion: Our algorithm suggests different therapeutic strategies for skin coverage and healing, depending on the size of the lesion and the exposed structures, and seems to offer good results. These procedures should be combined with NPWT to optimise these results (improved healing, reduced infections, decreased skin defects and enhanced granulation tissue) and so should be used more frequently.

Bacteriological profile and antimicrobial sensitivity pattern of isolates from diabetic foot of patients attending a teaching hospital in Northern India

Background: Diabetic foot ulcer is a major cause for diabetes related morbidity and hospitalization. Up to one-third of people with diabetes develop diabetic foot ulceration (DFU) during their lifetime and over 50% of these ulcerations become infected. Diabetic foot infections (DFIs) are associated with major morbidity, increasing mortality, high costs, increased risk of lower extremity amputation (LEA), and reduced quality of life. Aims and Objective: The current study was conducted to determine the microbiological profile and antibiotic susceptibility pattern of organisms in diabetic foot ulcers patients at a tertiary care center in Srinagar province. Material and Methods: This was a Cross-sectional, observational study conducted in diabetic patients with diabetic foot infection, randomly selected from outpatient departments (OPDs) and wards of Surgery and Medicine department, with Wagner grade 1-5 ulcers and irrespective of anti-diabetic treatment and diabetic foot injury treatment. Samples were processed and bacterial isolates were identified by standard microbiological procedures. Results: After following inclusion and exclusion criteria, 120 patients were considered for this study. In present study most common age group was 51-60 years age group (44%) followed by 41-50 years (32%). 66% of participants were males. 55% patients had diabetes for more than 10 years. 43% patients had ulcer size less than 5 cm2. The most common category as per Wagner’s classification was Grade 1, which comprised of 48% of study participants, followed by Grade 0 (28%) and Grade 2 (18%). Grade 3 and above comprised 7% of cases. Of the 120 study participants, 103 (86%) showed growth on culture. Among these 62 (60%) showed mono-microbial growth with 41 cases showing mixed growth. The most commonly isolated bacteria were Methicillin Resistant Staphylococcus aureus (MRSA) (23%), Coagulase Negative Staphylococci (CoNS) (18%), pseudomonas aeruginosa (18%), Methicillin Sensitive-Staphylococci Aureus (9%), Klebsiella Pneumoniae (9%), and Escherichia Coli (8%). Linezolid, vancomycin, clindamycin, gentamicin were most effective antimicrobial agents against gram positive bacteria. Iimipenem, piperacillin tazobactam, cefoperazone sulbactam & gentamicin were most effective antimicrobial agents against gram negative bacteria. Conclusion: Early microbiological evaluation for bacteriological profile, the nature of the infection either monomicrobial or polymicrobial and antibiotic sensitivity testing can improve treatmentoutcome, reduces complications, morbidity as well as multidrug resistance.

MO651DIABETES CARE IN HAEMODIALYSIS TREATMENT : ADVANCES IN 2020

Background and Aims Management of diabetes and follow-up of haemodialysis patients are still poorly standardized. The objective of this study is to establish a descriptive inventory of all routine parameters for monitoring diabetes and glycemic control by Continuous Glucose Monitoring (CGM). Method The study recruited 32 diabetic patients in a medical dialysis unit. Glycemic control was assessed using CGM (FreeStyle Free Pro®) over at least 11 days with measurement of: mean blood glucose level, percentage of blood glucose level: &lt; 70 mg/dl (TBR), between 70 and 180 mg/dl (TIR), and &gt; 180 mg/dl (TAR). The results are expressed in average or median [25-75 percentiles]. SPSS® statistical analyses compared extra and per dialytic periods. Results Patients’ mean age was 71±8 years, diabetes duration was 21±6.5 years (87.5% T2DM), mean weight was 77±13kg, HbA1c was 7±0.98%, 98% had a high risk of foot injury (Grade 2 and 3) . Only 46.8% of the patients were followed by a diabetes specialist and 84.3% were treated with insulin and 18.75% received oral medication while only 50% performed self blood glucose-monitoring. The average blood glucose level was 133±13 mg/dl (∼1000 measurements). CGM results for 32 patients over the total period were: TIR at 70% [58-76], TAR at 15% [4.6-29], and TBR at 9.6% [3.7-20].Per-dialytic TIR (84%; [76-93]) was significantly higher (p=0.02) than extra-dialytic TIR (68%; [56-75]). Per-dialytic TAR (5.5%; [0.0-10.7]) was significantly lower (p&lt;0.01) than extra-dialytic TAR (14%; [3.6-29]). TBR did not vary significantly. Conclusion The majority of patients were treated with insulin but only 50% performed self- of blood glucose. Hypoglycaemia was lower during dialysis period. 98% of patients had a high risk of foot injury. CGM could be a usefull tool for the evaluation of glycemic profile of haemodialysis patients, and allows a better adjustment of their treatment.

GAMBARAN PENGETAHUAN CARE GIVER PASIEN DIABETES MELLITUS PADA PERAWATAN KAKI DIABETIK

Background: Diabetes mellitus (DM) is a metabolic disease characterized by an increase in blood sugar levels due to damage to insulin secretion. Neuropathy is a common complication of diabetes mellitus. One way to prevent neuropathy or other complications is to do regular foot care. The role of caregiver in diabetic foot care is important to improve the quality of life of patients living with diabetes mellitus. They need to be provided with the latest knowledge and support regarding diabetic foot care. Purpose: Study was to determine the relationship between care giver knowledge about diabetic foot care and foot ulcers at risk of developing ulceration in DM. Methods: This study was an analytical study with a cross sectional study design. The research sample was 40 respondents who met the criteria. The data were collected using a knowledge questionnaire with 20 questions and a risk observation sheet for diabetic foot. Results: This study showed that most of the respondents had less knowledge about diabetic foot care, namely 26 (65%). The study also showed a relationship between the lack of knowledge about foot care and the risk of foot injury for people with diabetes, a = 0.05 (95% CI). Conclusion: This study has proven that a care giver must be equipped with diabetic foot care competency, and DM patinets can avoid complications of diabetic foot ulcers. Nurse should provide education to the community regularly, especially on the novelty of the knowledge that has been gained either from research or from the experience gained in the clinic or nursing home. Abstrak Latar Belakang: Diabetes melitus (DM) merupakan suatu penyakit metabolik yang di tandai dengan adanya peningkatan kadar gula darah akibat kerusakan pada sekresi insulin. Neuropati merupakan salah satu komplikasi diabetes melitus yang sering terjadi. Salah satu cara mencegahan neuropati atau komplikasi lainnya yaitu dengan melakukan perawatan kaki yang rutin. Peran care giver dalam perawtan kaki diabetik sangat diperlukan untuk peningkatan kualitas hidup pasien dengan diabetes mellitus. Mereka perlu diberikan pembekalan serta dukungan ilmu yang terbaru mengenai perawtan kaki diabetik. Tujuan: Adapun tujuan penelitian ini adalah untuk mengetahui hubungan antara pengetahuan care giver tentang perawatan kaki diabetik dengan kejadian kaki beresiko terjadinya ulkus pada penderita DM. Metode: Penelitian ini adalah penelitian analitik dengan rancangan penelitian cross sectional. Sampel penelitian sebanyak 40 responden yang memenuhi kriteria. Pengumpulan data dilakukan dengan menggunakan kuesioner pengetahuan dengan 20 pertanyaan dan lembar observasi resiko kaki diabetik. Hasil: Hasil Penelitian menunjukkan sebagian besar responden memiliki pengetahuan yang kurang tentang perawatan kaki diabetik yaitu sebesar 26 (65%). Penelitian juga menunjukkan adanya hubungan antara kurangnya tingkat pengetahuan tentang perawatan kaki dengan resiko terjadinya luka pada kaki penderita DM, a=0.05 (CI 95%). Kesimpulan: Penelitian ini telah membuktikan bahwa pendamping anggota keluarga yang sakit harus dibekali kompetensi perawatan kaki diabetik, dengan harapan penderita DM dapat terhindar dari komplikasi ulkus kaki diabetikum. Bagi kolega perawat untuk terus memberikan edukasi pada masyarakat khususnya terhadap kebaruan ilmu yang telah didapat baik dari penelitian ataupun dari pengalaman yang didapat diklinik atau rumah perawatan.