Diabetes is an increasingly common condition in western economies, and whilst attempts to both prevent and then manage the condition are improving, a new study highlights the challenges that still exist when it comes to remission of foot ulcers resulting from diabetes.

The study suggests that healthcare providers wrongly focus their efforts on repairing the tissue surrounding the ulcer, and thus healing the wound, when they should be focusing their attention on the remarkably high frequency of remissions.  The authors suggest that roughly 1/3 of diabetics will develop a foot ulcer, which can have severe consequences.

“This paper is the first of its kind to call attention to remission. The word ‘remission’ has been mentioned in the literature over the last few years. But this is the loudest call yet, and more than any other work before, [it] lays out data in a way that sort of flips the script from healing to what we do in between healed wounds,” the authors say.

Reducing foot ulcers

The paper reveals that nearly 40% of patients suffer from foot ulcers within a year of getting their first one, with that figure rising to 75% of patients having a recurrence within five years.  The authors believe that diabetes is perhaps not giving the same attention as other conditions, such as cancer.

“Diabetes can be more significant than many forms of cancer. This is a concept that’s misaligned right now in medicine. As we move toward diseases of decay, as I call them—things like cancer, cardiovascular disease, diabetes—our goal as physicians, surgeons, scientists, and policymakers is to delay that decay,” they say.

Foot ulcers can be particularly challenging because people can unknowingly develop them.  Sores may develop but are out of sight and the individual may not suffer any pain as a result.  It is nonetheless incredibly serious, with a diabetic foot ulcer meaning the sufferer is half as likely to live an additional 10 years as someone who hasn’t developed one.  It also significantly increases the chances of hospitalization.

“We looked at the data from 5 billion outpatient visits and found that diabetic foot ulcers and diabetic foot infections were astonishingly high-risk factors for hospitalization,” the authors say.

The paper argues for clinicians to have an honest conversation with patients, in much the same way as they do with other diseases, such as cancer.  Remission can be prolonged significantly by things such as physical activity and continuous care, and so the healthcare provider needs to offer such support services to try and ward off remission.

“The real idea here is for physicians to help people move through their world a little better and give them more ulcer-free days and more activity-rich days,” the authors say. “We want to keep our patients moving, so they’re not on the sidelines of life.”