Spanish Society of Diabetes Warns Diabetic Foot Complications, Including Ulcers and Amputation Risk

Diabetic foot is described as one of the most serious complications of diabetes, developing when elevated blood glucose levels damage the nerves and blood vessels of the feet and lead to ulcers, infections, and even a risk of amputation.

“Critical limb ischemia (CLI) caused by diabetes, tobacco use, and end-stage renal disease remains, to this day, the leading cause of lower-limb amputation”

Doctissimo

The Spanish Society of Diabetes (SED) is cited as saying the prevalence of diabetic foot has reached almost 15% of the population, affecting one in seven adults.

Doctissimo

Dr. Fernando Gallardo, co-director of the Angiology and Vascular Surgery department at Quirónsalud Campo de Gibraltar Hospital, warns that "Ulcers are wounds and open injuries that can be painful and difficult to heal."

He adds that ulcers can become infected and, in severe cases, spread quickly and endanger life by causing septic shock, with delayed care sometimes requiring amputation of one or more toes, the entire foot, or even the leg.

Gallardo says treatment focuses on preventing complications, improving circulation to the extremities, healing wounds, and controlling infection, while also stressing that feet should be checked daily and that appropriate footwear and orthotic insoles are important.

SciELO España describes Pedal Acceleration Time (PAT) as a noninvasive diagnostic alternative measured by Doppler ultrasonography, proposed partly because noninvasive arterial studies can be limited in diabetics, the elderly, and patients with chronic kidney disease (CKD) due to medial arterial calcification.

PAT is defined as "the interval from the onset of the systolic upstroke to its point of maximal acceleration" on the Doppler arterial flow velocity curve.

La Razón

The Medellín, Colombia study is cited with a PAT-based distribution, including "PAT less than 120 ms: normal ABI" and "PAT greater than 160 ms: ABI less than 0.5."

SciELO España also notes that a prospective study published in 2021 found PAT values less than 180 ms were associated with better outcomes, and it links shorter PAT to a better limb prognosis.

The article further specifies a measurement protocol using a 7-12 MHz linear transducer at four sites, with the angle of measurement "60 degrees or less" and a recommendation to perform 20 supervised evaluations to achieve an adequate learning curve.

Doctissimo reports that an American clinical trial published on March 30 in the New England Journal of Medicine tested transcatheter arterialization of the deep venous system for critical limb ischemia, a condition it says remains the leading cause of lower-limb amputation.

“INTRODUCTION The global prevalence of peripheral arterial disease ranges from 3% to 12%”

SciELO España

The PROMISE II trial is described as studying 105 patients with critical limb ischemia treated with a minimally invasive system designed to bypass blocked arteries and restore blood flow to the foot via the veins, with "More than 75% of patients were able to avoid amputation."

Doctissimo quotes Daniel Clair, the study's lead author, saying, "The patients with long-standing diabetes and severe vascular disease of the foot often have no means to restore sufficient blood flow to the foot to heal the wounds."

VIDAL’s recommendations for lower-extremity peripheral artery disease define chronic limb-threatening ischemia (formerly critical limb ischemia) by clinical signs including non-healing chronic limb ulcer (≥ 2 weeks) and gangrene associated with hemodynamic criteria such as ankle systolic pressure < 50 mmHg.

VIDAL’s guidance also states that revascularization should be performed as quickly as possible to save the limb and that "In case of failure or technical impossibility of revascularization, amputation may be necessary."