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Diabetisk fotsår

Sist oppdatert: Sist revidert:
Sist revidert av:
Definisjon:
Diabetisk fotsår er en følge av senkomplikasjonene nevropati og aterosklerose
Forekomst:
Prevalensen av diabetiske fotsår blant pasienter med diabetes i Skandinavia varierer i ulike studier mellom 3% og 8%
Symptomer:
Sår som oppstår på områder på føttene som stadig er utsatt for trykk
Funn:
Det oppstår et kronisk sår som ofte blir infisert.
Diagnostikk:
Ofte er det påkrevd med mikrobiologisk undersøkelse av sårsekret. Ved usikkerhet om underliggende osteomyelitt, tas røntgen
Behandling:
Optimal kontroll over diabetessykdommen og lokal sårbehandling
  1. Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet, online 2003; 361: published online Feb 25.
  2. Gürgen M, Kaal A, Witsø E. Diabetiske fotsår. Tidsskr Nor Lægeforen 2005; 125: 899-902. PubMed  
  3. Cavanagh PR, Lipsky BA, Bradbury AW, Botek G. Treatment for diabetic foot ulcers. Lancet 2005; 366: 1725-35. PubMed  
  4. Edmonds ME, Foster AVM. Diabetic foot ulcer. BMJ 2006; 332: 407-10. PubMed  
  5. Helsedirektoratet. Nasjonale faglig retningslinje for diabetes. Oslo; Helsedirektoratet 2019. helsedirektoratet.no  
  6. Apelqvist J, Larsson J. What is the most effective way to reduce incidence of amputation in the diabetic foot? Diab Metab Res Rev 2000; 16 (suppl 1): 575-83.
  7. Henriksson F, Agardh CD, Berne C et al. Direct medical costs for patients with type 2 diabetes in Sweden. J Intern Med 2000; 248: 387-96. PubMed  
  8. Henriksson F, Agardh C-D, Berne C, et al. Direct medical costs for patients with type 2 diabetes. J Intern Med 2000; 248: 387-96. PubMed  
  9. Muller IS, de Grauw WJC, van Gerwen WHEM, et al. Foot amputation and lower limb amputation in type 2 diabetic patients in Dutch primary health care. Diab Care 2002; 25: 570-4. PubMed  
  10. Reiber GE, Lipsky BA, Gibbons GW. The burden of diabetic foot ulcers. Am J Surg 1998; 176: 5S-10S. PubMed  
  11. Tennvall GR, Apelqvist J, Eneroth M. Costs of deep foot infections in patients with diabetes mellitus. Pharmacoeconomics 2000; 18: 225-8. PubMed  
  12. Witsø E, Rønningen H. Lower limb amputations: registration of all lower limb amputations performed at the University Hospital of Trondheim, Norway, 1994-1997. Prosthet Orthop Int 2001; 25: 181-85. PubMed  
  13. Trautner C, Haastert B, Spraul M et al. Unchanged incidence of lower limb amputation in a German city. Diabetes Care 2001; 24: 855-9. PubMed  
  14. Group TG. Epidemiology of lower limb amputations in centres in Europe, North America and East Asia. The global lower extremity amputation study group. Br J Surg 2000; 87: 328-37. PubMed  
  15. Watkins PJ. ABC of diabetes. The diabetic foot. BMJ 2003; 326: 977-9. PubMed  
  16. Peters EJ, Lavery LA. Effectiveness of the diabetic foot risk classification system of the International Working Group on the Diabetic Foot. Diabetes Care 2001; 24: 1442-7. PubMed  
  17. The International Working Group on the Diabetic Foot. Praktiske retningslinjer - den diabetiske fot. WHO-retningslinjer for behandling av den diabetiske fot omarbeidet til norsk. 1. Oslo: Norsk interessefaggruppe for sårheling og Norges Diabetesforbund, 2001.
  18. Jeffcoate W, Lima J, Nobrega L. The Charcot foot. Diabet Med 2000; 17: 253-8. PubMed  
  19. Helsedirektoratet (2021). Nasjonal faglig retningslinje for antibiotika i primærhelsetjenesten nettdokument. Oslo: Helsedirektoratet (sist faglig oppdatert 16. november 2021, lest jan 2022).
  20. Rith-Najaran S, Branchaud C, Beaulieu O et al. Reducing lower extremity amputations due to diabetes. Application of the staged diabetes management approach in a primary care setting. J Fam Pract 1998; 47: 127-32. PubMed  
  21. Frykberg RG, Franks PJ, Edmonds M, et al. A Multinational, Multicenter, Randomized, Double-Blinded, Placebo-Controlled Trial to Evaluate the Efficacy of Cyclical Topical Wound Oxygen Therapy (TWO2) in the Treatment of Chronic Diabetic Foot Ulcers: The TWO2 Study. Diabetes Care 2019. pmid:31619393 PubMed  
  22. Lewis J, Lipp A. Pressure-relieving interventions for treating diabetic foot ulcers. Cochrane Database of Systematic Reviews, March 2013. CD002302.pub2. Cochrane (DOI)  
  23. Armstrong DG, et al. Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomized controlled trial. Diabetes Care 2005; 28: 551-4. PubMed  
  24. Bradley M, Cullum N, Sheldon T. The debridement of chronic wounds: a systematic review. Health Technol Assess 1999; 3: no 17, part 1.
  25. Edwards J, Stapley S. Debridement of diabetic foot ulcers. Cochrane Database of Systematic Reviews, 21 April, 2011. CD003556.pub2. Cochrane (DOI)  
  26. Falanga V. Classification for wound bed preparation of chronic wounds. Wound Rep Regen 2000; 8: 347-52. PubMed  
  27. O'Meara S, Cullum N, Majid M, Sheldon T. Systematic review of wound care management: (3) antimicrobial agents for chronic wound; (4) diabetic foot ulceration. Health Technol Assess 2000; 4: no 21.
  28. Dumville JC, Lipsky BA, Hoey C, et al. Topical antimicrobial agents for treating foot ulcers in people with diabetes. Cochrane Database Syst Rev. 2017 Jun 14;6:CD011038. PMID: 28613416 PubMed  
  29. Armstrong DG, Nguyen HC. Improvement in healing with aggressive edema reduction after debridement of foot infection in persons with diabetes. Arch Surg 2000; 135: 1405-9. PubMed  
  30. Huang Y-Y, Lin C-W, Cheng N-C, et al. Effect of a Novel Macrophage-Regulating Drug on Wound Healing in Patients With Diabetic Foot Ulcers A Randomized Clinical Trial. JAMA Netw Open 2021. doi:10.1001/jamanetworkopen.2021.22607 DOI  
  31. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998; 352: 837-53. PubMed  
  32. NSAMs referansegruppe for diabetes. NSAMs handlingsprogram for diabetes i allmennpraksis. 2005.
  33. O'Reilly D, Pasricha A, Campbell K, et al. Hyperbaric oxygen therapy for diabetic ulcers: systematic review and meta-analysis. Int J Technol Assess Health Care. 2013;29(3):269-81. doi: 10.1017/S0266462313000263. DOI  
  34. Liu R, Li L, Yang M, et al. Systematic review of the effectiveness of hyperbaric oxygenation therapy in the management of chronic diabetic foot ulcers. Mayo Clin Proc 2013 Feb;88(2): 166-75. doi: 10.1016/j.mayocp.2012.10.021. DOI  
  35. Fedorko L, Bowen JM, Jones W, et al. Hyperbaric oxygen therapy does not reduce indications for amputation in patients with diabetes with nonhealing ulcers of the lower limb: A prospective, double-blind, randomized controlled clinical trial. Diabetes Care 2016; 39: 392-99. doi:10.2337/dc15-2001 DOI  
  36. Santema KTB, Stoekenbroek RM, Koelemay MJW, Reekers J. Hyperbaric Oxygen Therapy in the Treatment of Ischemic Lower Extremity Ulcers in Patients With Diabetes: Results of the DAMO2CLES Multicenter Randomized Clinical Trial. Diabetes Care. 2017. PMID: 29074815 PubMed  
  37. Santema TB, Poyck PPC, Ubbink DT. Skin grafting and tissue replacement for treating foot ulcers in people with diabetes. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD011255. DOI: 10.1002/14651858.CD011255.pub2 DOI  
  38. Moore ZE, Corcoran MA, Patton D Nutritional interventions for treating foot ulcers in people with diabetes. Cochrane Database Syst Rev. 2020 Jul 17;7:CD011378. doi: 10.1002/14651858.CD011378.pub2. DOI  
  39. Boyko EJ, Zelnick LR, Braffet B, et al. Risk of Foot Ulcer and Lower-Extremity Amputation Among Participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study. Diabetes Care 2022; 45: 357-364. pmid:35007329 PubMed  
  40. Morrison WB, Ledermann HP, Schweitzer ME. MR imaging of inflammatory conditions of the ankle and foot. Magn Reson Imaging Clin N Am 2001; 9: 615-37. PubMed  
  41. Lauvrak V, Frønsdal KB, Ormstad SO, Vaagbø G, Fure B. Effekt av hyperbar oksygenbehandling ved senskader etter stråleterapi eller diabetiske fotsår. Rapport fra Kunnskapssenteret - Systematisk oversikt nr. 4 - 2015. ISBN 978-82-8121-945-8 ISSN 1890-1298
  • Terje Johannessen, professor i allmennmedisin, Trondheim

Tidligere fagmedarbeidere

  • Stein Vaaler, overlege dr. med., Senter for Klinisk Epidemiologi, Rikshospitalet, Universitetet i Oslo