Metabolic disorders like obesity and diabetes are on the rise. For example, more than 11% of the population is living with diabetes in the US. It means that in some urban areas, even more than 15% of people may be living with diabetes, considering that diabetes prevalence is higher in urban centers1.

Most of these are individuals living with type 2 diabetes, as the prevalence of type 2 diabetes is above 90% in the US. It is a chronic disorder, a diagnosis for a lifetime. It means that people living with diabetes struggle to control it adequately. As a result, most people living with diabetes have inadequate control over blood sugar levels.

Poorly controlled diabetes leads to a range of complications. Diabetes may cause both acute and chronic complications. However, the more significant concern is chronic complications of blood vessels and nerves when it comes to type 2 diabetes.

Diabetes is the leading cause of vasculopathies and neuropathies. It affects both the large and small blood vessels over time. Thus, most diabetes-related complications are due to worsening vascular health.

Diabetes is among the leading causes of heart disease, stroke, and peripheral artery disease. In addition, it is the leading cause of chronic kidney disease, retinopathy, and foot infections.

Diabetes and foot infection

Diabetes is the leading cause of foot infections. Data suggests that 25% of all those living with diabetes may expect to develop foot infection, sometimes in their lifetime2. Nevertheless, there is a considerable difference in the severity of the infection between individuals. There are significant differences in the diabetes severity.

In diabetes, foot infection occurs primarily due to changes in the blood supply. Peripheral vasculopathy causes significantly reduced blood flow to the feet. It means a reduced supply of nutrients, slow immune response, and thus considerable risk of developing the infection.

It is also worth understanding that diabetes foot infections may continue to progress if not managed adequately. Moreover, there are high chances of having multiple antibiotic-resistant infections. Studies suggest that about one-third of those infected have methicillin-resistant Staphylococcus aureus. Additionally, these wounds are infected by gram-negative bacilli and even anaerobes. Thus, diabetic food infections tend to be polymicrobial.

But not only that, due to low blood supply and changes in the nerve ending, foot infections also tend to behave very differently in those living with diabetes, and thus challenges in the treatment. For example, in diabetes, bacterial agents may form a biofilm and therefore not allow the entry of antiseptics into the wound.

Simply said, diabetes foot infection does not respond well to traditional treatments. It means a higher risk of spreading of the infection. Studies show that diabetes foot infection is the leading cause of non-traumatic foot amputation globally.

Diagnosis and treatment of diabetic foot infection

First and foremost, it is essential to understand that prevention is the best policy for diabetes. Thus, those living with severe diabetes should regularly inspect their feet. Moreover, due to neuropathy, many may not even feel the pain caused by minor trauma.

The treatment approach would depend on the severity of the condition:

Grade 1–almost no local or systemic signs of infection.

Grade 2 – local mild infection without the involvement of deeper tissues.

Grade 3 – moderate infection with severe abscess and infection affecting deeper tissues, causing osteomyelitis and severe systemic signs.

Grade 4 – local signs of severe infection with severe systemic symptoms.

When it comes to managing mild and moderate infections, doctors recommend strictly controlling the blood glucose level and antibiotic therapy. In the case of mild infection, oral antibiotic therapy may help. However, if the condition becomes severe, one would need systemic antibiotic therapy.

In more severe cases, doctors would need to carry out surgical treatment like debridement of the wound, which involves removing the dead tissues so that antibiotics can penetrate the living cells well.

Importance of diagnosing and treating peripheral artery disease in diabetes

Even the best treatment fails to prevent frequent foot infections in some individuals. Studies show that undiagnosed peripheral artery disease is the primary cause of foot infections progression in diabetes. It is the reason that leads to amputations. It means that doctors specializing in vascular diseases should be an essential part of the diabetic foot management team.

Those who havea diabetic foot infection, even a mild infection, should immediately seek help from a vascular surgeon. Studies estimate that peripheral arterial disease is present in 50-60% of all cases of diabetes foot infection3.

Doctors may use many methods to assess the feet’ blood flow, like palpating pedal pulse. However, experts warn that it is not a reliable way of estimating the condition, and such physical signs are pretty unreliable, especially in the early stages of peripheral artery disease (PAD).

Generally, it is good to consult a specialized clinic in vascular disease management. In such clinics, doctors are well trained to diagnose and manage even minute vascular deficiencies. They would use various specialized equipment and procedures to diagnose the condition, from ultrasound to angiography.

If doctors find the presence of PAD, they may recommend treatment depending on the severity of the blockage. In less severe cases, they might recommend blood-thinning agents and other medications. However, more severe cases would need revascularization.

There are many ways of revascularization or improving blood flow to the feet, thus helping not only overcome foot infection in diabetes but also preventing amputation. Specialists may use methods like angioplasty, or more severe cases may need artery bypass graft (bypassing the blocked part of the blood vessel).

To conclude, managing PAD is an essential and yet one of the neglected ways of managing diabetic foot. Anyone living with diabetes and feet infection must understand that PAD is present in 50-60% of all diabetic foot infections. Thus, all people, even those with mild infections, should undergo examination at a specialized vascular disease management clinic. Not only that, depending on the severity of diabetes, one should preferably get checked by specialists at least once a year.

References

  1. National Diabetes Statistics Report | Diabetes | CDC. Published January 20, 2022. Accessed April 3, 2022. https://www.cdc.gov/diabetes/data/statistics-report/index.html
  2. Uçkay I, Aragón-Sánchez J, Lew D, Lipsky BA. Diabetic foot infections: what have we learned in the last 30 years? International Journal of Infectious Diseases. 2015;40:81-91. doi:10.1016/j.ijid.2015.09.023
  3. Boulton AJM, Armstrong DG, Kirsner RS, et al. Diagnosis and Management of Diabetic Foot Complications. American Diabetes Association; 2018. Accessed April 3, 2022. http://www.ncbi.nlm.nih.gov/books/NBK538977/