BACKGROUND: It is known that patients with renal failure have normochromic normocytic anemia due to impaired endogenous erythropoietin (EPO) synthesis. The aim of this work was to determine whether low serum erythropoietin (s-EPO) levels play a role in the pathogenesis of anemia in patients with Type 1 diabetes without overt nephropathy. METHODS: We included in the study 13 patients with Type 1 diabetes whose Hb levels were <11 g/dl. Blood cell count, s-EPO, urinary albumin excretion rate (AER), HbA(1c), glomerular filtration rate, serum iron, serum ferritin, the presence of neuropathy, retinopathy and nephropathy were determined. RESULTS: Ten out of 13 patients with anemia (77%) had a blunted EPO response to anemia. All ten patients with low EPO levels had autonomic neuropathy; five had clinical nephropathy but with serum creatinine<1.6 mg/dl. Three patients were treated with rHuEPO and showed an improvement in their anemia after treatment. CONCLUSION: The majority of patients with Type 1 diabetes who had anemia also had low EPO levels. The pathogenesis of this phenomenon is probably multifactorial. Autonomic neuropathy appears to play a role, but it is not sufficient, per se, to be the only cause. Dysautonomia might enhance the effect of renal damage.

Adult↗

PubMedDate not supplied

The diabetic foot: epidemiology.

The epidemiology of the diabetic foot is still unknown because this heterogeneous pathologic condition is non uniformly classified and described. Lower limb peripheral vascular disease has a preferential distal location strongly associated with the classical factors of cardiovascular risk. Ulcers occur in 15% of diabetics and 6-20% of all hospitalized diabetic patients are affected by ulcers of the foot. There is a predictive feature of the severity of the ulcer in relation to its location. In the USA, ischemia-related amputations are about 200 per million per year for non diabetics as against 3900 per million for diabetics; furthermore the incidence of a second amputation rises to 51% 5 years after first amputation. Risk factors for amputation are: smoking, hypertension, dyslipidemia, elderly age, glycosylated hemoglobin levels. Although mortality has decreased in the last 50 years, the diabetic foot is still a huge economic problem.

Amputation, Surgical↗

PubMedDate not supplied

Charcot's foot.

Diabetic osteoarthropathy is a chronic progressive arthropathy involving the bones and joints being constantly associated to somatic and autonomic peripheral neuropathy. The pathogenesis is related to sensory and motor neuropathy with morphologic foot alterations, relaxation and abnormal position on walking till complete collapse of the foot shown by the depressed longitudinal medial arch. Bone reabsorption due to osteoclasis and increased blood flow until osteomalacia appears, is characteristic of this arthropathy. The clinical features vary according to the location and severity of articular impairment and the stage of identification. The metatarsophalangeal or tarsometatarsal joint may be involved. The typical manifestation of Charcot's foot is plantar ulcer of variable location according to the weight-bearing area. Treatment tends to reduce the abnormal stress predisposing to ulceration with tailored footwear and orthoses.

Adult↗

PubMedDate not supplied

Infection of the diabetic foot.

Infection may be the first manifestation of the diabetic foot or may complicate a preexisting lesion. The increased susceptibility to infections of diabetics and the particular anatomy of the foot make infections particularly severe and rapidly progressive. The etiology is generally polymicrobial and a swab for culture of microorganisms is immediately required to plan correct and adequate antibiotic therapy based on the antibiotic sensitivity test. Infections can be treated in specialized outpatient services, while hospitalization is reserved to most severe cases with systemic manifestations. These specialized centers have been shown to be the only structures able to decrease the frequency, severity and recurrence of foot infections as well as their prevention.

Bacterial Infections↗