We are now less than two months away from America's biggest diabetes conference, the ADA annual meeting taking place in Boston this year, where diabetes and feet will play a starring role. That is, new treatment updates will be on the agenda, even as we PWDs in attendance find our own feet paying the price for hustling around the huge conference center for days on end.
April happens to be National Foot Awareness Month, so it's no coincidence that we have had diabetes foot health on the mind lately and were drawn to the title of one talk listed in the ADA advance program: "The Great Debate: Current Controversies in Diabetic Foot Care."
While we know that neuropathy and all the foot problems that diabetes can cause are nothing to make light of, this actually made me smirk, thinking: "Really?! That's a great debate? With actual conference-worthy controversy?"
The D-Foot Debate(s)
Turns out this ADA session planned for the morning of June 6 is not a wide-ranging look at diabetes foot complications at all. Rather, it's focused specifically on two issues: hyperbaric oxygen therapy (HBOT) for treating foot ulcers, and a complication known as osteomyelitis that often requires months of antibiotics or even surgery, related to some of the scariest foot problems for those of us with diabetes: foot ulcers, and amputations. Neither are fun to think about, but it's good to know about this HBOT treatment option, which has apparently been an ongoing debate because not all physicians agree it's the way to go for treating foot ulcers.
Basically, HBOT treatment involves exposing your body (or the particular foot area) to 100% oxygen, since oxygen helps wounds heal quicker than they might otherwise. It's much less invasive than traditional treatments, which involve removing the effected tissue on the foot. Some of the research that's been done on HBOT seems to show that it's pretty effective. But there are still many in the medical community who consider it an unproven, "fringe" treatment.
So at ADA in June, two global experts will hold a Point-Counterpoint discussion on its relative merits.
The second debate topic, osteomyelitis (often shortened to OM) is an infection or inflammation of the bone, most often seen in PWDs with diabetic foot ulcers. Some new research from late 2014 shows that treating it with a short run of antibiotics might be more effective than first thought, better than some of the medical organizations currently recommend. One recent study shows that six weeks of antibiotics might be sufficient for treating patients with diabetic OM -- rather than three months or longer -- and possibly a way to avoid foot surgery.
OK, maybe not the most tantalizing of topics to think about... but hey, it's important stuff!
A New App for Wounds
OK, so one in four people with diabetes (PWD) will develop foot complications, according to those in the know. We've tackled neuropathy and other bad foot stuff in our 411 series on diabetes complications in the past, and there are many resources out there for people searcing for that info.
But now... there's an app for that!
Yep, a pilot clinical study will be starting soon at UMass Medical School for a new Android app called "Sugar" (name choice not ideal) that would not only help PWDs better manage weight and glucose levels, but also assess the status of chronic foot ulcers. Developed at the Worcester Polytechnic Institute, the app will be able to share data with your glucose meter and weight scale, and users can manually enter data about exercise and physical activity. The app will prompt users with updates on things like how often they tested today compared to past days, or how long it's been since they exercised.
What's novel is the focus on wound-assessment. Using it, you can snap a picture of your feet or any ulcers with your phone's camera, and have those images analyzed to determine how severe they might be -, helping you decide if it might be worth staying home and off your feet, when and how to dress the wound, or whether you need to go immediately to the doctor's office for evaluation and treatment.
A research paper was published on this wound assessment system in February, and in a news story on the Sugar app, the lead developer Dr. Peder Pedersen of WPI said this:
"A key feature of the app is its ability to track the wound area and healing status, then report the information in a format easy for patients and their caregivers to understand. For the first time, this system will give patients the ability to play an active role in their wound care."
Sounds pretty impressive, and fits right in with the app-everything world we're living in. Glad to hear that diabetes foot care is a part of the mhealth revolution!
My Own Foot Path
On a personal note, I've had my fair share of diabetes -- and not D-related -- foot issues in the past. It's been about 15 years since that first time I felt sharp pains in my toes and feet, thanks to neuropathy. Back in my teens and then early 20s, my D-management wasn't anything to write home about and I was starting to feel the consequences. My neuropathy got so severe that it often kept me up at night, and at the office, I frequently had to get up from my desk and walk around just because my feet were bothering me.
Medication helped, as did better blood sugar management -- just like doctors tell you. Eventually, it faded away and stopped impacting my daily life. Now, any foot discomfort almost serves as a red flag that my sugars are higher, because that's the only time my feet or toes really bother me.
Luckily, I never experienced any foot ulcers or more serious complications of the feet, but it sure is good to know that if and when I ever do, my diabetes foot care choices will be fully vetted by some great minds. (Fun fact: there's an Australian twitter feed called Mind Your Feet that gives advice for prevention of foot-related issues.)
In the meantime, I will be interested in hearing how doctors debate these things...
And don't worry: I plan to wear sturdy shoes and good socks and mind my feet when I'm at the ADA conference in June. I'm sure the docs would be happy to know that!