Better control of blood glucose levels can reduce the risk of diabetic foot ulcer

First study in people with type 1 diabetes that demonstrates the relationship between poor control of glucose levels and an increased risk of foot ulcers. Patient follow-up was more than 20 years.

Hyperglycaemia, or excessive blood glucose, is related to complications such as progressive damage to the capillaries of the retina and kidney, atherosclerosis, high blood pressure, obesity and others. All of them lead to serious problems, such as diabetic foot ulcer, which is a significant risk factor for the amputation of lower limbs. Intensification of glycaemic control in people with type 1 diabetes mellitus is known to reduce the risk of damage to the nervous, renal and retinal systems. Intensification of glycaemic control is optimising or improving glucose levels with an insulin pump, which is a small device that continuously delivers insulin.

A study of over 1,000 patients with insulin intensification treatment, via multiple doses or an insulin pump, led to a reduction in the risk of retinopathy (disease of the retina), nephropathy (disease of the kidney) and neuropathy (disease of the nervous system). At the end of the study, most of the patients agreed to participate in a new one to assess the effect of intense long-term glycaemic control. After 23 years follow-up, those patients who had received intensive treatment in the first study had better A1c (glycosylated haemoglobin) and a lower risk of developing complications.

Glycosylated haemoglobin is used as a biomarker for monitoring blood glucose levels. The higher this value, the poorer blood sugar control the patient with diabetes has. The A1c value should generally be below 7.5%. The higher this value and the longer it remains high, the greater the risk of complications. Receiving intensified treatment compared to conventional treatment was associated with a statistically significant reduction in all types of diabetic foot ulcers.

This is the first study in people with type 1 diabetes mellitus that shows the relationship between poorer metabolic control and an increased risk of suffering foot ulcers. The study is important due to its magnitude and duration; adding one more complication to the list of problems that can potentially be prevented with intensified glycaemic treatment.

These data show the importance of controlling diabetes well from its onset. A patient is generally free of complications in this initial phase, so it is sometimes difficult for professionals to convey the importance of carrying out a whole series of therapeutic strategies that may seem to be unnecessary at that time. This work shows the importance of insisting on maintaining good control for patients with type 1 diabetes, even when there are no apparent chronic complications of the disease.

Photo: Intensification of insulinic treatment with insulin pump.

Information documented by: Dr Enric Esmatjes, Senior Endocrinologist at the Hospital Clínic Endocrinology Service and former member of the Translational Research Group on diabetes, lipids and obesity.