Prevention of Diabetic Wounds
Prevention of diabetic injuries and the wounds they cause is first by strict glycemic control, that is, keeping the target hemoglobin A1c level < 7.0
Injuries that progress toward amputation require prosthetics. Prevention of new injuries from prosthetics is crucial. This is accomplished via fitting by professional prostheticians. Thereafter, routine follow-up re-checks of the equipment is necessary to appraise it for wear-and-tear and changes in the patients that result in ill-fitting.
Arterial compromise as part of peripheral vascular disease can be monitored via imaging studies, including contrast media and ultrasound. Venous compromise may necessitate compression stockings which require great caution to prevent superficial necrosis of the skin.
Aggressive debridement of pressure ulcers and other sites of infection is for stopping their progress, which can pose a risk of sepsis.
Management of hypertension with anti-hypertensive medication is indicated and a routine of periodic evaluations to determine cardiac health will not only improve mortality, but offer extra opportunities for surveillance of healing injuries.
Smoking cessation, a reasonable ADA diet with reasonable expectations, and a team approach that includes the primary care physician, endocrinologist, wound team, dietitian/nutritionist, and when necessary, physiatry and physical therapy.
The best global approach to prevention is by frequent inspection of the feet and legs by podiatry and primary care to identify any areas with warning signals.