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Цель. Изучение влияния экзогенного серотонина и стволовых клеток жировой ткани на репаративные процессы гнойно-некротических ран мягких тканей при ишемической форме синдрома диабетической стопы (СДС). Материалы и методы. В исследование включено 35 больных, из которых 20 имели ІІ стадию, 15 - ІІІ стадию ишемической формы СДС по классификации Фонтейна-Покровского на фоне сахарного диабета 2-го типа. Контрольную группу составили 15 здоровых людей, при обследовании которых не были выявлены признаки поражения артерий нижних конечностей. О степени выраженности атеросклероза судили по данным липидограммы и рентгенографии дуги аорты. В эксперименте изучено влияние стволовых клеток жировой ткани на регенеративные процессы в хронической язве кролей. Результаты. Внутривенное введение серотонина адипината улучшало кровоток в нижних конечностях, что может быть связано, во-первых, с механизмами эндотелиальной зависимости вазорелаксации, во-вторых, с усилением выработки эндотелиальных вазодилататоров. Проведенные экспериментальные исследования по изучению влияния стволовых клеток жировой ткани на репаративные процессы в хронической язве показали потенциальные возможности применения этих клеток в лечении пациентов с язвенно-некротическими дефектами. Выводы. Внутривенное введение серотонина адипината благоприятно влияет на патогенетические механизмы развития ишемии атеросклеротического генеза. Клеточная терапия стволовыми клетками жировой ткани у животных с хроническими язвенными дефектами улучшает репаративные процессы в поврежденных тканях. Это позволяет заключить, что такая терапия обладает потенциальными возможностями в лечении больных с гнойно-некротическими ранами мягких тканей.

Diabetes is an incurable metabolic disease whose neglect can lead to serious health complications. It is caused by a malfunction or insulin secretion by the pancreas. Diabetes is more and more often diagnosed in society and has become a disease of civilization. An increase in the incidence of diabetes is expected in the coming years. Inadequate treatment and inadequate control may cause hyperglycaemia, causing a number of consequences associated with an increase in glycaemia levels. Diabetic foot syndrome causes damage to peripheral nerves or vessels of the foot. Early detection of abnormalities allows to take appropriate action, therefore an important element of prevention of a person suffering from diabetes is foot control. Ignoring the symptoms may lead to the development of ulceration and infection or even at a later stage to amputation of the limb. The aim of the study is to present appropriate prophylaxis, care and treatment in the care of a patient with diabetic foot syndrome. The paper is based on a review of articles in reputable journals from the last few years.

Abstract Background Early detection of diabetic foot ulcerations (DFUs) can avoid or delay any progression into more severe stages, which may require limb amputation or lead to infectious sequelae and death. However, frequent clinical screening would be too intrusive and costly, and self-examination may be hampered by concomitant diseases and social disabilities. In addition, it requires professional knowledge and experience using specialized devices. Researchers reported that skin temperature monitoring could reduce the risk of DFUs in high-risk patients. The main research objects in this field are effective and convenient means of temperature measurement, accurate and reasonable early warning mechanisms, and timely and appropriate interventions. This trial aims to investigate the effectiveness of daily home-based foot temperature measurements in the prevention of DFUs with the aid of intelligent sensor-equipped insoles combined with photo documentation. Methods/Design In this open-label, prospective, randomized, 24-month trial, 300 patients with diabetes mellitus (type 1 or 2) and severe diabetic peripheral neuropathy (vibration sensation ≤ 4/8), aged 18–85 years, will be recruited and assigned to control and intervention groups in a ratio of 1:1. Main inclusion criteria to be eligible for study participation encompass in particular risk group 2 or 3 for the development of DFUs using the diabetic foot risk classification system (as specified by the International Working Group on the Diabetic Feet [IWGDF]) and the ability to use a mobile phone. Interventions Participants in both groups will receive education about regular foot care at the beginning of the study (visit 0). In the intervention group, every patient will receive a pair of slippers with the inserted sensor-equipped insole as well as a smartphone with the corresponding smartphone application (Smart Prevent Diabetic Feet Application). The insole is a tool that records the temperature variabilities of the plantar foot. Patients will measure their foot temperature twice a day at home with a time interval > 4 h during the entire course of the study (24 months). The measured data will be initially analyzed and visualized, and further transferred to a remote server that allows the physician to perform specific interpretations. In case of temperature differences > 1.5 °C between left and right corresponding sites lasting > 32 h (assigned alarm level 4), the physician will start an intervention phase, which requires the patient to reduce daily activities and relax his feet for five days. At the same time, photo documentation is encouraged to be performed by the patient. Possibly, additional visits to a private doctor or clinical examinations will be arranged for the patient during this intervention period. Outcomes: The primary outcome is foot ulceration, evaluated by a physician, and occurring at any point during the study. Discussion This study addresses principal aspects in the prevention of DFUs. First, the sensor-equipped insole will be evaluated for daily performance in home-based measurements of foot temperatures. Second, a telemedicine structure is tested that evaluates sensor data automatically and proposes suitable intervention measures under the supervision of a physician. Third, predictive models for DFUs will be built using the collected sensor data allowing for interpretations, which in the future may support medical care providers. Trial registration German Clinical Trials Register (DRKS), DRKS00013798. Registered on 18 January 2018.

Peripheral arterial occlusion and microvascular disorders are important factors that contribute to the onset of lower limb disease in patients with diabetes. Monckeberg's sclerosis (arteriosclerosis) arteriosclerosis is diagnosed as a random finding when performing radiography of the upper or lower extremities, but may be a complicating factor in systemic response syndrome and sepsis in patients with diabetic foot syndrome. Purpose of the study. Analyze the condition of the blood flow of lower limb in patients with diabetes foot syndrome with signs of sepsis, in dependence on the level of Monckeberg's sclerosis. Materials and methods. 75 patients with diabetes were examined, due to diabetic foot syndrome. 11 (14,7%) patients had type I diabetes, the average duration of which was 16,41 ± 3,85 years, 64 (85,3%) patients had type II diabetes, with of 12,25 ± 2,54 years duration. The age of patients with type I diabetes was 35 ± 5,72 years, with type II diabetes was – 63,51 ± 10,22 years. Men with type I diabetes were 63%, with type II diabetes – 53%. According to the latest recommendations Sepsis-3 (2016) and classification criteria, patients had signs of sepsis, which required a certain combination therapy. Patients with sepsis were divided into two groups: group I consisted of 38 patients with an infected ulcer, abscess and phlegmon; to group II of 37 patients with gangrene of the toes, forefoot, gangrene of the entire foot or lower limb. The first group of 38 patients included 5 with type I diabetes and 33 with type II diabetes. By age, sex, concomitant pathology of the group was representative. Main vessels were investigated using ultrasound duplex scanning. Determined arterial systolic pressure at the level of the ankle, with the subsequent calculation of the ankle-humeral index, Arterial systolic pressure was also determined at the level of I toe. We had conducted radiography of the foot in two projections. We had Used X-ray classification of Monckeberg's sclerosis (V. A. Gorelysheva et al., 1989) in stages. Research results. Patients in both groups were examined identically. The treatment was carried out in accordance with the standards of patient management with the development of sepsis; surgical intervention was justified on the basis of information obtained from the survey and clinical data. Patients of group I were performed: dissection of an abscess, phlegmon, sequestrectomy and arthrotomy. In group II – one or several fingers amputation, transmetatarsal amputation of the foot, amputation at the level of the calf or thigh. 33 (86,8 %) patients of group I and 30 (81,0%) patients of group IIhad signs Monckeberg's sclerosis varying stages. In 19 (58%) patients, group I, the X-ray picture of the distal arteries matched to grade 3 according to the presented classification Monckeberg's sclerosis, 9 (27%) patients had signs of grade IV, 3 (9%) – grade V. 6 (20%) patients, II groups had an X-ray picture of grade III, 13 (43%) patients had signs of grade IV, 11 (36%) had signs of grade V. All 9 patients with type I diabetes had signs of arteriosclerosis. Using X-ray data, it is possible to classify Monckeberg's sclerosis by stages. However, with the duration of the disease for more than 10 years, the calcifications of the walls of the arteries of the foot in the form of a convoluted dense rope or column with simultaneous defeat of the smaller branches, which is characteristic of the final stages of the disease. Despite the fact that as a result of calcifications, the vascular wall becomes rigid and loses the ability to reduce and dilate, the blood flow in it is preserved, and the level of SAT varies from > 200 to 80 mmHg. The presence of Monckeberg's sclerosis by radiography of the lower extremities was detected in 33 (86.8%) patients in group I and 30 (81,0%) in group ІІ. With an increased level of vascular involvement, Monckeberg's sclerosis increases the likelihood of developing critical ischemia and gangrene (х2 = 5,41; р = 0,02). In patients of group I with systolic blood pressure of more than 120 mmHg the disease outlook was more favorable than in patients without a pulse wave or systolic blood pressure of the finger less than 80 mmHg (х2 = 11,76; р = 0,0006). With a decrease in systolic blood pressure of less than 30 mmHg to save the distal part of the foot or the limb did not succeed. Calcification of the vascular wall does not affect the arterial patency directly, but after the formation of thrombosis, the blood flow stops. Conclusions. In patients with sepsis, with signs of diabetic foot syndrome, which are characterized by a neuropathic form (ulcer, abscess, phlegmon), the presence of Monckeberg's sclerosis, even the last stages, with preserved systolic blood pressure of 200–120 mmHg does not lead to the development of critical deterioration blood circulation. Deterioration of the rheological conditions of the lower extremity, with a systolic arterial pressure 80–50 mmHg below in combination with stage III–IV Monckeberg's sclerosis increases the risk of gangrene of the foot and limb. In the presence of Monckeberg's sclerosis of 3–5 stages in the small arteries of the foot, it is possible to maintain the integrity of the foot by maintaining a generally sufficient volume of blood flow, due to the fight against atherosclerosis of main vessels, to maintain systolic blood pressure not lower than 80–60 mmHg.

Purpose of the study. To study frequency of fatal sepsis, the causes and severity of diabetes patients complicated by diabetic foot syndrome of the gangrene limb, after amputation of the lower limb at the hip level. Material and methods. Amputation of the lower limb at the hip level was performed in 180 patients with diabetic foot, gangrene of the limb. 15 (8,3%) died. Results. From the 15 patients who died, 9 died from sepsis. The age was 54–78 years old. On admission, sepsis was diagnosed in 5 and septic shock – in 4 patients. After examination and preparation, emergency surgeries were performed in 4 patients and urgent surgeries – in 5. Twoand three-step surgeries were performed in 5 patients. They first performed the removal of the toes of the gangrene, osteomyelitis, opened deep phlegmon of the foot and the lower leg was completed by amputation of the lower limb. Primary amputations were performed in 4 patients. Sepsis was the cause of death in 5 patients from 11 to 60 days and the combinations of sepsis with acute myocardial infarction or repeated myocardial infarction – in 4 from 5 to 17 days. During the autopsy, pathological changes of severe diabetes, complicated diabetic foot syndrome, its mixed form, sepsis with manifestations of septicemia or septicopyjemia, and all organs and systems were revealed. Conclusions. The unsatisfactory organization of medical care for patients with diabetes and diabetic foot syndrome at the pre hospital stage, ineffective sanitary and educational work, systemic pathological changes led to sepsis and death after the amputation of the lower limb at the hip level.

Purulent-necrotic complications in patients with diabetic foot syndrome is one of the main causes resulting in amputation and disability, or even lethal outcome. Our study was aimed at investigating a role played by MRSA and related molecular genetic features, as well as antibiotic resistance in developing purulent-necrotic forms of the diabetic foot syndrome in Krasnoyarsk, in the 2010–2016 period. A microbiota profile related to purulent-necrotic complications, antibiotic susceptibility, as well as the molecular genetic features of methicillin-resistant Staphylococcus aureus were examined in 240 patients with diabetic foot syndrome. A bacteriological method was used to investigate microbiota profile related to purulent complications. Antibiotic sensitivity was analyzed by disc-diffusion method; staphylococcal antibiotic sensitivity was evaluated by screening, PCR, solid medium serial dilution, in accordance with the CLSI and EUCAST international recommendations. Genotyping and examining molecular genetic features were performed by using PCR, M-PCR, and sequencing. The data were analyzed by using WHONET (WHO) software. Significance level was set at p

One of the main problems of modern surgery is treatment of trophic skin and soft tissues defects due to the ambiguity of the pathogenesis, tendency to recurrence, deterioration in the patients’ quality of life, complexity and duration of treatment, large economic costs of treatment and rehabilitation. The article describes an algorithm for outpatient treatment of patients with trophic skin and soft tissues defects in diabetic foot syndrome. Debridement the wound from necrosis, purulent-fibrinous pellicles, wound biofilms is produced by a chemical necrectomy. A method of closing the wound defects by the means of high-tech biomaterials based on collagen type 1 is described.

Background. To analyze the results of the radionuclide diagnostic method in patients with neuroischemic form of diabetic foot syndrome before and after conservative treatment. Materials and methods. 18 patients with neuroischemic form of diabetic foot syndrome were selected for the research. They received only conservative therapy and surgical debridement. The patients underwent a standard range of laboratory and instrumental studies, and underwent scintigraphy of the lower extremities with the radiopharm Tcpyrfotech drug before and after receiving a course of conservative therapy. Results. After conservative therapy, 13 (72.2%) patients noted an improvement in their condition, noted a decrease in pain in the affected limb, an increase in painless walking distance, and healing of ulcers. In 5 (27.8%) patients, no positive dynamics was observed against the background of conservative therapy. When conducting scintigraphy of the lower extremities before treatment, in all patients with a visual comparative analysis of scintigrams, an uneven pattern was observed in the accumulation of radiopharm drug in symmetrical leg muscles with an area of muscle hypoperfusion in the affected lower extremity. Before treatment, the quantitative indicator of impulses from the muscles of the affected leg averaged 414 ± 36.2, the “healthy” leg − 990 ± 35.1. After treatment, the number of impulses from the affected limb increased to an average of 606 ± 42.8, in the “healthy” one to 1097 ± 35.4. The increase in the number of impulses from radiopharm drug in the affected lower limb in dynamics during treatment is statistically significant (Critical value of Student’s t-test 2.11, p = 0.000). Conclusions. Carrying out radionuclide diagnostics of the lower extremities in dynamics for patients with diabetic foot syndrome makes it possible to assess the effectiveness of the treatment, and to revise the tactics of patient management in a timely manner. Further research in this area will reveal the potential of this research method.

Infectious complications of diabetic foot syndrome (DFS) clearly increase the morbidity of patients with DFS, contribute to a higher incidence of lower limb amputa‑ tions, but in some cases may increase the risk of death. Therefore, it is always necessary to diagnose the infection early and properly and quickly start its aggressive treatment. This manuscript describes in detail the diagnosis and treatment of DFS infection based on recent recommendations of the International Working Group on Diabetic Foot (IWGDF) DFS. [ABSTRACT FROM AUTHOR]

We have analyzed the experience of treatment of 563 patients with diabetic foot syndrome. We have developed an algorithm for the treatment of patients, including modern diagnostic and treatment methods, in particular - endovascular correction of vascular disorders and vacuum aspiration. The use of new technologies in the treatment of patients with diabetic foot syndrome improves their quality of life and social adaptation.

Introduction: Efforts to improve survival in sepsis are based on a series of urgent medical interventions. The article presents the data obtained in the process of complex treatment of patients, in which sepsis was caused by complicated diabetic foot syndrome. Materials and Methods: The article presents materials on the retrospective study of treatment results of 1678 patients with complicated diabetic foot syndrome. In 146 patients (8.7%) the disease was burdened with sepsis. Results: A common feature of the treatment strategy for patients in both groups was surgical intervention, the administration of antibiotic therapy (ABT) and infusion- transfusion therapy. With the help of developed algorithms, it was managed to improve the results of septic patients' treatment. Conclusions: The applied tactics of treating patients with sepsis has allowed to reduce the frequency of execution of high amputations and postoperative complications, increase the number of "small" amputations, which led to a reduction in mortality, shortening the length of patients' stay in the hospital. [ABSTRACT FROM AUTHOR]

Objective. To assess the outcomes of the treatment of patients with suppurative necrotic complications of diabetic foot syndrome (DFS) without critical ischemia with the use of programmed rehabilitation technologies (PRT).Material and methods. The study included 82 patients. 40 patients (reference group) underwent conventional rehabilitation, while 42 patients (study group) were treated with PRT with the use of the original equipment AMP-01.Results. Use of PRT has been established to significantly improve the quality of rehabilitation, which helps to reduce the duration of inpatient treatment. The number of suppurative complications in the study group proved to be significantly less (p=0.014), and postoperative mortality was lower. The long-term outcomes of the treatment (number of late suppurative complications, ischemia progression, maintenance of foot support ability) in the study group was also found to be significantly better compared to the reference group.Conclusion. The use of PST promotes the improvement of short-term and long-term outcomes of the treatment of the patients with DFS suppurative necrotic complications.

The work was aimed at analysing the annual results of outpatient observation of patients with trophic ulcers (TU) on the background of diabetes mellitus while applying modern principles of general and differentiated local treatment in the Diabetic Foot Room (DFR) environment. The authors carried out a retrospective analysis in a cohort of patients with diabetic foot syndrome (DFS), who visited a practitioner to receive advice and treatment in the DFR in 2015–2017 (n = 570). Of which, only 308 people have been treated on an outpatient basis. Neuropathic form (n = 194): diabetic osteoarthropathy (DOAP) (A0) = 63, DOAP + TU = 34; TUs without DOAP = 131 (AI 105, BI 26). Neuroischemic form (n = 114), all had TUs (CI 107, D I 7). The patients received glucose-lowering therapy correction, feet relief and differentiated local effects on TUs in accordance with the wound process stages. All options of modern wound dressing were used for indications. As a result, out of 83 patients with neuropathic DFS form, who were regularly observed in DPT, 65 (78.3%) patients achieved healing within 1 year. Of 103 patients with the neuroischemic form regularly observed in DFR, 76 (73.8%) patients achieved epithelialization, 19 patients (18.4%) reported unhealed TUs, 3.9 and 3,9% of patients had small and high amputations, respectively. 96.1% of patients achieved preservation of the supporting limb. Differentiated treatment and dynamic observation in the DFR environment made it possible to reduce the number of high limb amputations in patients with diabetic TUs within 1 year of observation to the minimum.

Nawaf J Shatnawi,1 Nabil A Al-Zoubi,1 Hasan Hawamdeh,2 Yousef S Khader,3 Abd El-Karim Omari,1 Muhammad R Khammash1 1Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Basic Medical Science, Faculty of Medicine, Hashemite University, Zarqa, Jordan; 3Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan Purpose: The aim of this study was to present the redefined clinical spectra of diabetic foot syndrome (RCS-DFS) and determine whether the RCS-DFS can be used to predict amputations. Patients and methods: This is a retrospective study of type 2 diabetic patients referred with DFS for management at King Abdullah University Hospital (KAUH) between January 2014 and December 2015. Data collection form and diabetic foot (DF) characteristic chart were used to document the following: demographic data, diabetes-related parameters, DF characteristics, surgical interventions and amputations. The predominant clinical presentations of DF problems (ulcer, sepsis or gangrene) were integrated with the clinical criteria for diabetic foot infection (DFI) diagnosis and classification of Infectious Diseases Association of America (IDSA)/International Working Group on Diabetic Foot (IWGDF) to redefine the clinical spectra of DFS. Related risk characteristics and amputation rate at all levels were compared between the three RCS. Results: In this study, there were 95 (47.0%) septic DFS (SDFS) patients, 65 (32.2%) ulcerative DFS (UDFS) patients and 42 (20.8%) gangrenous DFS (GDFS) patients. Poor glycemic control (HbA1c >7.5%), hypertension, history of the same foot problems, duration of symptoms, revascularizations and ischemic severity were significantly different between the three RCS. UDFS had the highest rate of limb salvage without amputations (70.8%). GDFS had the highest rate for final toe amputations (52.4%) and major amputations (23.8%). Final minor amputation rate was around 20% for both SDFS and GDFS. Conclusion: Redefining DFS into ulcerative, septic and gangrenous by integration of the predominant clinical presentation and the clinical criteria for DFI diagnosis and classification of IDSA/IWGDF showed significant differences in amputation rate. Therefore, it can be used clinically to categorize patients with DFS to predict amputations and to help in planning their management. Further prospective studies are suggested to validate these results. Keywords: diabetes mellitus, classification, diabetic foot syndrome, amputations

Objective. To compare the efficacy of different methods of surgical treatment for stenotic-occlusive affection of the lower extremities (LE) arteries in patients with ischemic form (ІF) of diabetic foot syndrome (DFS). Маterials and methods. Results of surgical treatment were analyzed in 164 patients, suffering diabetes mellitus Type II, complicated by IF of DFS with critical ischemia on background of combined stenotic-occlusive affection of the femoral and popliteo-tibial segments arteries. Results. Primary passability of the femoral reconstruction zone was registerd in 65.6% of patients, in whom reconstruction of femoral arterial segment was performed without intervention on arteries of popliteo-tibial segment, and the secondary one – in 81.9%, high amputations rate have constituted 18% and lethality – 11.5%. Primary passability of the femoral reconstruction zone was registered in 89.5% patients, to whom a two-level reconstruction of femoral and popliteo-tibial arterial segments was performed, and a secondary one – in 92.1%, high amputations rate have constituted 5.2% and lethality – 7.9%. Primary passability of the femoral reconstruction zone was registered in 81.5% patients, to whom hybrid arterial reconstruction was performed, and a secondary one – in 93.9%, high amputations rate have constituted 7.7% and lethality – 4.6%. Conclusion While coexistence of the superficial femoral artery (SFA) occlusion with stenotic-occlusive affection of the popliteo-tibial segment arteries in patients, suffering stenotic-occlusive affection of arteries in popliteo-tibial segment in cases with IF of DFS the results of performance of isolated operation for the SFA restoration were the worst. The results of a two-level and a hybrid operations may be considered comparable. Primary passability of the arterial reconstruction zone in patients, to whom a two-level reconstruction was performed, is highest, but lethality almost twice as bigger, than after hybrid arterial reconstruction. Hybrid reconstructive operation constitutes optimal procedure in patients, suffering lower extremities (LE) arteries affection in cases with the ІF of DFS, combined with stenotic-occlusive affection of arteries in femoral and popliteo-tibial segments.

Aim. To establish the features of the spectrum and antibiotic resistance of bacterial agents isolated from wounds in patients with diabetic foot syndrome.Materials and methods. In 2016-2017 a retrospective cohort study was carried out on the basis of the archive of the municipal budgetary healthcare institution «City clinical hospital №6» in Chelyabinsk with analyzing the data of the medical cards of patients who were at the department of purulent surgery in 2015 with various forms of diabetic foot syndrome. The main data for the study were taken from the results of bacteriological studies. To determine the antibiotic susceptibility of the isolated flora, a diffusion method was used with discs with antibiotics. The classification proposed by Wagner F.W. was used to determine the prevalence and depth of the lesion of diabetic foot syndrome (1979). The statistical processing of data was carried out using Excel 12.0 (Office 2008), the level of significance of the results was evaluated by calculating the two-sided exact Fisher test (F) using the calculator on the site «Medical Statistics» (URL: http://medstatistic.ru/calculators/calchi.html).Results. In the studied group of patients with diabetic foot syndrome the infectious process caused by one bacterial agent was most often encountered. The most common causative agent isolated from the wound defects was S. aureus. The tendency to develop resistance against antibiotics, widely used in clinical practice, is more pronounced in representatives of gram-negative flora.Conclusion. The obtained data generally coincide with the results of studies in the field of the microbial spectrum of the wounds in diabetic foot syndrome determined by other authors, but the predominance of monoinfections over bacterial associations in this studied population requires further study.

Abstract Background Diabetic foot is one of the most significant and devastating complication of diabetes. The objective of this study was to assess the prevalence of diabetic foot syndrome (DFS) and the associated risk factors among people with diabetes mellitus. Methods A community based cross-sectional study was carried out among 620 subjects with diabetes mellitus (DM) in rural areas of Udupi district. The Michigan Neuropathy Screening Instrument was used to identify peripheral neuropathy. Ankle brachial index was used to identify peripheral arterial disease (PAD). Subjects with diabetic foot syndrome were classified according to the International Working Group on Diabetic Foot (IWGDF) classification system. Results The overall prevalence of DFS was 51.8%. Among them 31.3, 11.9 and 8.5% belonged to category 1, 2 and 3 respectively. Multivariate logistic regression analysis showed advancing age, low socio-economic status, sedentary physical activity and longer duration of DM were significant independent correlates of DFS. Conclusion The overall prevalence of DFS was high among the study population; hence the screening for foot complications should start at the time of diagnosis of diabetes integrated with sustainable patient education at primary care level by training of health care providers at primary care level.

Nawaf J Shatnawi,1 Nabil A Al-Zoubi,1 Hassan M Hawamdeh,2 Yousef S Khader,3 Khaled Garaibeh,4 Hussein A Heis1 1Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Basic Medical Science, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Orthopedic Surgery, Jordan University of Science and Technology, Irbid, Jordan Purpose: This study was conducted to determine the risk factors of major lower extremity amputations in type 2 diabetic patients referred for hospital care with diabetic foot syndrome. Patients and methods: This retrospective study involved 225 type 2 diabetic patients referred for management of diabetic foot syndrome at King Abdullah University Hospital in the period between January 2014 and December 2015. A structured customized diabetic foot data collection form with diabetic foot characteristics chart was used for documentation of relevant information, which checks for age, sex, body mass index, smoking, duration of diabetes, diabetic control therapy, associated hypertension, cardiac diseases, stroke, chronic renal impairment, renal replacement therapy (hem-dialysis), and history of diabetes-related complication in both feet prior to the study period. The predictors for major lower limb amputations were compared between groups using chi-square test, and binary logistic regression was used to determine the factors associated with major amputation. Results: Twenty-seven limbs underwent major amputations with an overall rate of major amputation of 11.6%. The following predictors were found to be associated with the higher incidence of major lower limb amputations: duration of diabetes ≥15 years, HbA1c ≥8%, patients on insulin, with hypertension, cardiac diseases, chronic renal impairment, stroke, having gangrene, higher number of components, higher Wagner classification, and ischemia. However, the rate did not differ significantly between men and women. Conclusion: Presentation with gangrenous tissue and poor glycemic control are the important risks and significant predictive factors for type 2 diabetes-related major lower limb amputations. Keywords: diabetes mellitus, amputations, diabetic foot complication, gangrene

The article analyzes the questions of treatment of inpatients with diabetic foot syndrome in a surgical hospital. A complex approach is offered and criteria of choosing methods of revascularization and rehabilitation are presented. The immediate and long-term results of the implemented scheme of patient management were studied, its advantages and disadvantages were revealed.

Diabetes, which commonly occurs in society, often contributes to the development of adverse complications in the form of micro and macroangiopathy and neuropathy. Irregularities within these structures are the causes of development of diabetic foot syndrome. The prophylaxis plays a very important role in case of people with diabetes. It is recommended to choose the right, individually designed footwear that will prevent the formation of wounds on the feet. In the period of prevention, hygiene and foot control also play an important role in preventing the development of calluses or the formation of cuts. Among people suffering from diabetes, wounds tend to be difficult to heal, therefore, if the wounds occur, comprehensive treatment should be undertaken. In addition to the standard methods of wound supply, it is necessary to unload this body part. It is recommended to wear unloading footwear or insoles that are specially designed for the patient's needs. Computer foot diagnostics is helpful in choosing the right footwear, it assesses the distribution of foot pressure on the ground while walking (dynamic test) and standing (static test).

Background. The chronic complications of diabetes mellitus (DM) result from a wide variety of effects of disease. The correlation between blood sugar level and chronic complications has been demonstrated in various studies. Patient education, risk factor management, and other preventative measures are critical elements in reducing the incidence of diabetes complications such as Diabetic Foot Syndrome (DFS). We purposed to evaluate knowledge and attitudes towards foot care amongst patients with diabetes mellitus; in addition, we investigated the correlation between glycemic control and DFS. Materials and methods. This was a descriptive cross-sectional evaluation of patients who were diagnosed with diabetes mellitus seeking outpatient medical care with data being collected through patient surveys, clinical evaluation, specialty consultation, and biochemical analysis of glycated haemoglobin (HbA1c) serum levels. The population of the study was composed of 90 patients diagnosed with DM. Results. A total of 90 patients, 42 (46.7 %) females and 48 (53.3 %) males were included in the study. The rate of participants who reported completing daily self-evaluations for wounds, cracks, and discoloration on the feet was significantly higher (68.9 %) than those who reported not evaluating on a daily basis (31.1 %). Almost half of the participants were diagnosed with DFS (n = 43; 47.7 %) with the HbA1c levels of patients with DFS being significantly higher compared to the HbA1c levels of patients without DFS (p < 0.05). Conclusions. As a high incidence of DFS was found with a positive and statistically significant correlation between the HbA1c level and DFS presence, our study highlights the importance of close monitoring, education, and treatment given the risk of serious complications of DM such as DFS in setting of poorly controlled DM. [ABSTRACT FROM AUTHOR]

There are ca. 8 million persons with diabetes mellitus living in Germany. A late sequelae of diabetes is the diabetic foot syndrome (DFS), the prevalence of which is greatly increasing. It comprises all alterations of the foot as a result of diabetic polyneuropathy as well as microvascular and macrovascular (peripheral arterial occlusive disease, PAOD) alterations. Many of the ca. 250,000 newly diagnosed diabetic foot ulcers per year become chronic wounds. Despite intensive efforts for prevention, early diagnosis and adequate wound care, ca. 13,000 persons with diabetes undergo major limb amputation in Germany every year. With consistent treatment in interdisciplinary centers and by exhausting all possible methods of wound treatment, pressure relief as well as arterial revascularization, the major amputation rate in patients with diabetic foot problems can be reduced by 80%. With a suitable strategy of prevention, the recurrence rate of foot ulcers would be reduced. [ABSTRACT FROM AUTHOR]

Background: Purulent lesions of the feet in diabetes mellitus bring excruciating suffering to the patient, reduce the quality of life and often lead to limb amputation and possible death. The disappointing results of the treatment of purulent complications of diabetes encourage the search for both new approaches to treatment and methods for assessing the reparative potential of wound defects. Aim: This study aimed to improve the treatment of purulent-necrotic complications of the diabetic foot by studying the morphological assessment of healing processes when using promising treatment methods such as then programmed debridement. Methods: Over the past 10 years, the results of treatment of 106 patients with purulent-necrotic complications of diabetic foot syndrome (DFS) without critical ischemia have been analyzed. The patients were randomized into two groups. In the experimental group (n = 55), after surgical treatment, the wound was sutured tightly, and in the postoperative period, programmed debridement was carried out using the original AMP-01 device. In the control group of patients (n = 51), the purulent wound was not sutured after the operation, and local treatment was carried out with solutions of iodophors, ointments based on polyethylene glycol. To assess the dynamics of reparative processes in purulent wounds, a cytological method was used, which makes it possible to quickly and reliably assess the stage of the wound process and the effectiveness of the treatment. The simplicity and availability of the method allows it to be recommended to all practicing specialists. Results and Discussion: In the experimental group, by day 9 after surgery, the number of degenerative forms of neutrophils in cytological smears was 2.9 times lower than in the control group - 12.3 ± 0.3% versus 36.4 ± 0.4% (p <0.001) - and the RDI indicator in experimental group was 3.4 times higher compared with the control group - 2.6 ± 0.1 and 0.9 ± 0.1, respectively (p <0.001). This indicated more active phagocytosis, more rapid cleansing of the purulent cavity. An earlier appearance of cells of young connective tissue was observed in the experimental group. The number of fibroblasts by day 9 after surgery was 4.6 times higher (6.4 ± 0.4%) than in the control group - 1.4 ± 0.1% (p <0.001), which confirmed the presence of active regenerative processes in the wound. Conclusions: The use of programmable sanitation technologies in treating purulent complications of a diabetic foot leads to a more significant reduction in the duration of the inflammation phase and acceleration of reparative processes. [ABSTRACT FROM AUTHOR]

The National Register of Paid Health Services (NRHZS) – recently specified the number of patients with diabetic foot syndrome (DFS) and the number of diabetic patients after amputation and helped us evaluate podiatric care. An online conference of the European Diabetic Foot Study Group (DFSG) took place in September 2020 during the coronavirus epidemic. Among the most interesting topics were the use of plantar pressure measurements after surgical resections of metatarsophalangeal joints, home measurements of skin temperature on the feet to prevent recurrence of ulcers, improving telemedicine communication between podiatrists during coronavirus epidemics, the impact of early podiatric care on In patients with DFS, examination of the risk of DFS by a patch test for the diagnosis of peripheral autonomic neuropathy and acceleration of the healing of chronic ulces by amniotic membrane preparations. [ABSTRACT FROM AUTHOR]

Introduction Diabetic foot syndrome (DFS) is as a major source of morbidity and a leading cause of hospitalization in patients with diabetes. Aim To study the presence of cardiovascular morbidities among patients with DFS. Patients and methods This study was conducted on 60 patients having type 2 diabetes. They were divided according to presence or absence of DFS into two groups. Each group included 30 patients. History taking; vital signs with calculation of ankle-brachial index (ABI); systemic examination; laboratory investigations, including blood sugar, glycated hemoglobin, lipid profile, estimated glomerular filtration rate (eGFR), and insulin resistance index; carotid ultrasonography; and echocardiography were performed for all study participants. Results Patients with DFS had longer duration of diabetes; higher waist circumference, fasting blood sugar, triglycerides, and low-density lipoprotein; and lower ABI, eGFR, and insulin resistance index. Carotid intima-media thickness was higher in patients with DFS. Regarding echocardiography, significant differences were found between both groups in mitral valve E/A ratio, ejection fraction, and left ventricle end systolic volume. There was a significant positive correlation between Wagner grade of diabetic foot and glycated hemoglobin, triglycerides, and low-density lipoprotein, and a significant negative correlation between Wagner grade of diabetic foot and eGFR and ABI. Conclusion Presence of DFS was associated with cardiovascular morbidities. [ABSTRACT FROM AUTHOR]

Copyright of Nursing Perspectives / Ošetřovatelské Perspektivy is the property of Silesian University in Opava, Faculty of Public Policies in Opava and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of this study is to predict the incidence of diabetic foot syndrome in type 2 diabetic patients by measuring some parameters (IL-6, FBS, MDA, CP, BMI). Samples were obtained from (75) type II diabetic patients with and without diabetic complications (diabetic foot and diabetic neuropathy), as well as (25) healthy controls as a control group. They were divided into four groups: Group A (the control group):- It included (25) healthy individuals aged between (35-70 years). Group B (Diabetics type II without complications):- Includes (25) patients, their ages range (35-70 years). Group C (diabetic patients with diabetic neuropathy):- It included (25) patients whose ages ranged from (35-70 years). Group D (diabetic patients with diabetic foot syndrome):- Included (25) patients whose ages ranged from (35-70 years). The results showed a significant increase in the levels of (IL-6, FBS, MDA, CP) in all groups of type II diabetes patients with and without complications compared to the control group (P≤ 0.05). There was a significant increase in the parameters measured in the group of diabetic patients with type II diabetic foot syndrome (DF) compared to the group of diabetic patients with type II disease Diabetic neuropathy (DN), and the results also showed a significant increase in group DN compared to group of type II diabetic patients (DM) (P≤ 0.05). Our study show Interleukin-6 values, as well as oxidative stress, could predict the future incidence of diabetic foot syndrome. [ABSTRACT FROM AUTHOR]

Introduction and Methods  Diabetic rocker bottom foot with secondary infection exacts the expertise of a reconstructive surgeon to salvage the foot. The author selected 28 diabetic patients with secondarily infected Charcot's degenerated rocker bottom feet and reconstructed their feet using distally based pedicled fibula flap. Reconstruction was done in a staged manner. Stage 1 surgery involved external fixation following debridement. In stage 2, struts were activated for distraction and arthroereisis. In stage 3, the distally based pedicled fibula was used for reconstruction and beaming of the arches. Results  In this retrospective study, the author analyzed the outcome of all 28 patients using the Musculoskeletal Tumor Society Rating (MSTSR) score. The average MSTSR score was 27.536 in an average follow-up of 30.5 months. The limb salvage rate with the author's procedure was 96.4% (p = 0.045). Conclusion  Author's protocol for the staged reconstruction and salvage of the infected diabetic rocker bottom foot, using the pedicled fibula flap, will be a new addendum in the reconstructive armamentarium of the orthoplastic approach. [ABSTRACT FROM AUTHOR]

Copyright of Der Hautarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Diabetic foot syndrome (DFS) contributes to significant morbidity in diabetic patients. Diagnostic and therapeutic approaches to DFS may be summarised in clinical practice guidelines (CPGs) to aid clinical practice but may only benefit patients if the CPG is of high quality. This study determines the methodological quality of DFS CPGs using a validated assessment tool to identify CPGs adequate for use in clinical practice. Medline, EMBASE, and CPG databases were searched to 31 May 2019. Reference lists were also searched. Full text English evidence based DFS CPGs were included. CPGs based on expert consensus, guideline summaries, or those only available if purchased were excluded. Four reviewers independently assessed methodological quality using the Appraisal of Guidelines for Research and Evaluation II instrument. An overall guideline assessment scaled score of ≥80% was considered to be of adequate quality to recommend use. Sixteen CPGs were identified. Good inter-reviewer reliability (ICC 0.985, 95% CI 0.980–0.989) was achieved. Poor scores were noted in domains 2 (stakeholder involvement), 5 (applicability), and 6 (editorial independence). Significant methodological heterogeneity was observed in all domains with the most noted in domain 6 (mean scaled score 43.2 ± 32.1%). Four CPGs achieved overall assessment scores of ≥80%. Four CPGs were considered to be adequate for clinical practice based on methodological quality. However, elements of methodological quality were still lacking, and all CPGs had areas for improvement, potentially through increased multidisciplinary team involvement and trial application of recommendations. Methodological rigour may be improved using structured approaches with validated CPG creation tools in the future. Future work should also assess recommendation accuracy using available validated assessment tools. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Wound Management / Leczenie Ran is the property of Evereth Publishing Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Diabetologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Negative-pressure wound therapy (NPWT) is an adjunct modality in diabetic foot ulcerations (DFUs). Randomized controlled trials (RCTs) have shown its advantage over standard approaches; however, data from observational studies remain scarce.We performed a systematic review of observational non-RCTs evaluating NPWT efficacy and safety in patients with DFU. Methods: Electronic databases were searched for observational studies involving NPWT. The results of single-arm studies were presented as percentages of patients with the outcome of interest. A meta-analysis of comparative studies provided point estimates of outcomes. Continuous outcomes were reported as either weighted or standardized mean differences and dichotomous data as relative risks (RR). Results: The search identified 16 relevant observational studies, 12 single-arm, and 4 comparative, reporting on a total of 18,449 patients with DFU, of whom 1882 were managed with NPWT. In the NPWT-treated patients, ulcers were larger (average size range 6.6–27.9 cm2), as compared with controls (≤3 cm2). The pooled results showed healing and major amputation in 51% and 5% of NPWT patients, respectively. The meta-analysis of comparative studies revealed lower risk of major amputation [RR = 0.23 (0.07; 0.80)] in NPWT-treated patients. The pooled results for healing rate and risk of any amputation were inconclusive due to large between-study heterogeneity. Overall, 6 deaths out of 158 patients were reported, none of them related to NPWT. Serious adverse events occurred in 6% of patients on NPWT. Conclusions: This systematic review of observational studies provided supportive evidence that NWPT is an efficient and safe adjunct treatment in the management of DFUs. [ABSTRACT FROM AUTHOR]

A total of 2,431 patients with diabetic foot syndrome (DFS) who underwent inpatient treatment in the purulent surgery units of 6 large hospitals in Chelyabinsk were examined. Most patients with DFS suffered from type 2 diabetes (87,8%). Most (69,4%) of patients with purulent necrotic complications of DFS were over 60 years old (55,1% among men and 76,4% among women). The complications were subdivided into predominantly ischemic (gangrene, critical ischemia), predominantly neuropathic (pressure ulcers, osteomyelitis) and predominantly suppurative (purulent wounds, abscesses, phlegmon) according to the nature and the underlying cause for the development of purulent necrotic processes observed in various forms of DFS. The diabetic patients with neuropathy of the feet had pressure ulcers and chronic osteomyelitis lesions of the foot (44,6%) more often than those with ischemia (5,7%, p

Introduction: Diabetic foot syndrome, with ulcers, gangrene development and consequent amputation, represents a chronic complication of diabetes mellitus. Because of the high incidence it significantly contributes to the overall morbidity, disability and mortality of the patients suffering from diabetes. Patient's quality of life, already low with preexisting chronic complications of diabetes, extremly deteriorates with development of gangrene. Treatment is complex and prolonged. Objective: Case presentation of gangrene treatment in a 73 year old female patient with diabetes, on insulin therapy. The treatment included thioctic (alpha lipoic) acid containing medication, antibiotics, peripheral vasodilators, double lay­ered silicone polyurethane wound dressings for bandaging of gangrenous wound on the patient's right foot. Results: The result of this treatment was regression, healing and epithelialization of the gangrenous wound of the foot. Discussion: Diabetic foot is a chronic complication of diabetes mellitus which is frequently encountered by general practitioners and often is treated in primary health care. The appearance of ulcerations and gangrene makes treatment more complex, demanding regular surgical debridement procedures of the wound, and treatment of infection with wide spectrum antibiotics. Patients with pre-developed gangrene of the foot achieve faster healing and epithelialization of the gangrenous wound by using double layered silicone polyurethane wound dressing and medicamentous therapy, instead of classic wound dressing. Conclusion: A faster healing of the gangrenous wound is achieved by using double layered silicone polyurethane wound dressing and medical treatment with medicaments containing alpha lipoic acid, peripheral vasodilators and wide spec­trum antibiotics. Early diagnosis of diabetes mellitus with adequate and prompt treatment of the disease and its complications as well as patients education, reduces the risk of gangrene as the most serious manifestation of the diabetic foot condition with amputation as a consequence.

The research included 40 patients with chronic trophic ulcers of lower extremities of different etiology (arterial insufficiency — 14 patients, venous insufficiency — 20 patients, diabetic foot syndrome — 6 people). According to the data of prime bacteriological inoculation, the main pathogens were: gram-positive coccus (Staphylococcus spp., Staphylococcus aureus — 75%, Staphylococcus epidermidis — 7,5%) and yeast-like fungi (Candida albicans — 7,5%). Microbial semination in plentiful quantity (more than 106 KOE) was detected at first inoculation in 85% of the patients. The ointment «Oflomelid» was applied for the patients. After 20 days, the lack of growth and the decrease of contamination level (lower than critical (less than 10² KOE) were noted. A visual analog scale estimated an intensity of pain in patients and it consisted of 39,8% before the treatment, 27,1% — after 10 days, 14,6% — after 20 days. The «Oflomelid» application allowed the reduction of the terms of wound cleansing from nonviable tissues in majority of patients and gained the fast transition from the granulation to epithelization phase. The principle of wound management with the application of ointment «Oflomelid» should be followed in a moist environment. A modern wound dressing must be used after the ointment. This shortened the terms of separate-phase wound repair and decreased the terms of the whole period of trophic ulcers repair in patients with vascular and endocrine pathology.

Background and objective: There is evidence that the procalcitonin levels are usually correlated with the high sensitivity C-reactive protein levels in inflammatory conditions. Therefore, this study aimed to assess the simultaneous changes of the procalcitonin and hs-CRP levels in the diabetic foot syndrome complicated type 1 and 2 diabetes. Method: This observational study was carried in the Center of Diabetes Mellitus in Erbil, Iraq from 1st January to the 30th September 2015. A total number of 170 participants were enrolled in this study. They grouped into Group I (healthy subjects, n=30), Group II (type 1 diabetes with diabetic foot syndrome, n=70) and Group III (type 2 diabetes with diabetic foot syndrome, n=70). The anthropometric measurements, blood pressure, fasting serum glucose and lipid profile, and the inflammatory markers included high sensitivity C-reactive protein and procalcitonin were determined. Results: Group III patients had a significant longer duration and score of diabetic foot syndrome, higher anthropometric measurements, higher blood pressure and fasting lipid profile levels compared with Group II. Serum procalcitonin and high sensitivity C-reactive protein levels were significantly higher in diabetic patients compared with Group I subjects. The serum levels of procalcitonin and high sensitivity C-reactive protein of Group III patients (1.11±0.47 ng/ml; 12.48±2.57 mg/L) were significantly higher than corresponding values of Group II patients (0.334±0.094 ng/ml; 5.73±0.89 mg/L). A non-significant correlation between procalcitonin with high sensitivity C-reactive protein in Group II and III was observed. Conclusion: We conclude that the simultaneous measurements of high sensitivity C-reactive protein and procalcitonin as inflammatory biomarkers are not necessary because the correlation was not significant.

Aim. To investigate the impact of various wound dressings on wound bed neoangiogenesis in patients with different forms of diabetic foot syndrome (DFS). Subjects and methods. The clinical (local tissue oxygenation) and immunohistochemical (CD31) markers of foot soft tissue neoangiogenesis were evaluated in patients with DFS receiving negative pressure (NP) therapy and collagen-containing dressings (CCDs) versus standard treatment. 63 patients with neuropathic and neuroischemic (without critical ischemia) forms of DFS were examined after wound debridement. In the postoperative period, 21 patients received NP treatment, CCDs were applied to 21 patients, and 21 patients had standard treatment. Results. During NP therapy, there was statistically significantly intensified local microhemodynamics, as evidenced by transcutaneous oximetry (p < 0.05); the remaining two groups showed no statistically significant differences in transcutaneous oxygen tension during the treatment. Immunohistochemical examination revealed a significant increase in the number of newly formed vessels, as shown by anti-CD31 antibody staining (p < 0.05), in patients who had NP therapy and CCDs (p < 0.05). Conclusion. Vacuum (NP) therapy versus standard therapy most effectively affects wound bed neoangiogenesis. This is reflected in the increased local tissue microhemodynamics, as confirmed by immunohistochemical examination.

Objective: Conduct a comparative evaluation of the effectiveness of the surgical and medicamentous treatment of the complicated forms of the diabetic foot syndrome (DFS). Methods: The results of complex diagnostics and treatment of 310 patients with the complicated form of DFS for the period 2013-2016, hospitalized in the Surgical Department of the State Clinical Hospital № 3 in Dushanbe, were analyzed. The men were 132 (42.5%), women – 178 (57.5%). The age of the patients variated from 38 to 84 years. Duration of treatment from the moment of its fluctuation from 2 to 21 years. The absolute majority of patients who suffered from serious forms of diabetes mellitus (DM): DM type I – 8.2%, DM type II – 91.8%. Results: With the purpose to distalize the level of amputation to support function of the foot, against the background of appropriate conservative therapy, a two-stage operational tactic was used. At the first stage, opening rots and small surgical interventions on the foot were carried out, on the second stage the plastical substitution of shortcoming tissue of foot and forming of the stump on the level of under the one-third of the shin. A reduction of the lethality has come after amputation to 1.9%, in total lethality to 7.1%. Metatarsal resections and exarticulation of toes of foot in 92.5% of cases where the reason for the repeated hospitalization of patients with an ipsilateral limb in consequence of amiss orthopedical correction of the impaired supporting function. Conclusion: The main point of the treatment for patients with complicated forms of DFS is the timeliness and correctness of the choice of methods of surgical and medicamentous treatment. At the same time, it is necessary to adhere to the organo-saving and functionallyeffortless tactics of the operative interventions.

Background. Epidemiological studies in regions of Russia have revealed significant differences in the prevalence of diabetic foot syndrome (DFS). Aims. To determine the epidemiological characteristics and associated complications of DFS in Khanty-Mansi Autonomous Okrug (KHMAO)-Yugra Materials and methods. The epidemiological indicators and complications of diabetes were determined in diabetic patients in KHMAO-Yugra. The statistical reporting form №12 was used. Data from patients diagnosed with type 1 or type 2 diabetes and DFS were gathered from the service area of hospitals, the state registry (2007–2014) and outpatient clinics in the city of Surgut (2009–2014). A prospective observational study with active screening and characterisation of DFS was conducted. Results. Of all patients, 43% were at high/very high risk of developing DFS. DFS was diagnosed in 4.1% of patients with diabetes and was characterised as neuropathic (57.3%), neuroischaemic (35.1%) and ischaemic (7.6%). Conclusions. Prevention and early diagnosis of DFS is crucial in the prevention and reduction of amputations in patients with diabetes. Given that DFS can present in various forms, programmes aimed at promoting DFS awareness are required to increase the identification and treatment of this syndrome. Additionally, improvements in the statistical tests used and better organisation of the flow patients referred to general physicians, endocrinologists, podiatrists and surgeons, are also important in the prevention and early diagnosis of DFS and its associated complications.