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IntroductionThe pathophysiology of Charcot neuroarthropathy (CN) remains unclear. There are a number of hypotheses but these are not exclusive. In its clinical presentation, this complication intersects with the semiology of diabetic-induced neuropathy, such as peripheral hypervascularization and the appearance of arteriovenous shunt. The EPICHAR study is as yet an unpublished cohort of people living with diabetes complicated by CN (in active or chronic phase). Based on the findings of the EPICHAR study, this study aimed to investigate whether a reduction in the rate of hyperglycemia accompanies the onset of an active phase of CN.Research design and methodsHemoglobin A1c (HbA1c) levels were assessed 3 months (M3) and 6 months (M6) before the diagnosis of active CN (M0).Results103 patients living with diabetes and presenting active CN were included between January and December 2019 from the 31 centers participating in this study (30 in France and 1 in Belgium). The mean age of the participants was 60.2±12.2 years; the vast majority were men (71.8%) living with type 2 diabetes (75.5%). Mean HbA1c levels significantly declined between M6 (median 7.70; Q1, Q3: 7.00, 8.55) and M3 (median 7.65; Q1, Q3: 6.90, 8.50) (p=0.012), as well as between M6 and M0 (median 7.40; Q1, Q3: 6.50, 8.50) (p=0.014). No significant difference was found between M3 and M0 (p=0.072).ConclusionsA significant reduction in HbA1c levels seems to accompany the onset of the active phase of CN.Trial registration numberNCM03744039.

Diabetic foot ulcers (DFU) represent a growing public health problem. The emergence of multidrug-resistant (MDR) bacteria is a complication due to the difficulties in distinguishing between infection and colonization in DFU. Another problem lies in biofilm formation on the skin surface of DFU. Biofilm is an important pathophysiology step in DFU and may contribute to healing delays. Both MDR bacteria and biofilm producing microorganism create hostile conditions to antibiotic action that lead to chronicity of the wound, followed by infection and, in the worst scenario, lower limb amputation. In this context, alternative approaches to antibiotics for the management of DFU would be very welcome. In this review, we discuss current knowledge on biofilm in DFU and we focus on some new alternative solutions for the management of these wounds, such as antibiofilm approaches that could prevent the establishment of microbial biofilms and wound chronicity. These innovative therapeutic strategies could replace or complement the classical strategy for the management of DFU to improve the healing process.

Staphylococcus aureus is one of the main pathogens isolated from diabetic foot infections (DFI). The purpose of this study was to evaluate the importance of the persistence of S. aureus in this environment and the possible modifications of the bacterial genome content over time. Molecular typing of S. aureus isolates cultured from patients with the same DFI over a 7-year study revealed a 25% rate of persistence of this species in 48 patients, with a short median persistence time of 12weeks (range: 4–52weeks). Non-specific clonal complexes were linked to this persistence. During the follow-up, bla genes were acquired in three cases, whereas some virulence markers were lost in all cases after a long period of colonization (21.5weeks). Only one patient (2%) had a long-term persistence of 48weeks. The genome sequencing of a clonal pair of early/late strains isolated in this patient showed mutations in genes encoding bacterial defence and two-component signal transduction systems. Although, this study suggests that the long-term persistence of S. aureus in DFI is a rare event, genomic evolution is observed, highlighting the low adaptive ability of S. aureus to the specific environment and stressful conditions of diabetic foot ulcers. These results provide the basis for better understanding of S. aureus dynamics during persistent colonization in chronic wounds.

The polymicrobial nature of biofilms and bacterial interactions inside chronic wounds are keys for the understanding of bacterial cooperation. The aim of this present study was to develop a technique to study and visualize biofilm in live imaging under flow conditions (Bioflux™ 200, Fluxion Biosciences). The BiofluxTM system was adapted using an in vitro chronic wound-like medium (CWM) that mimics the environment encountered in ulcers. Two reference strains of Staphylococcus aureus (Newman) and Pseudomonas aeruginosa (PAO1) were injected in the BiofluxTM during 24 h to 72 h in mono and coculture (ratio 1:1, bacteria added simultaneously) in the CWM vs. a control medium (BHI). The quantification of biofilm formation at each time was evaluated by inverted microscopy. After 72 h, different antibiotics (ceftazidime, imipenem, linezolid, oxacillin and vancomycin) at 1x MIC, 10x MIC and 100x MIC were administrated to the system after an automatic increase of the flow that mimicked a debridement of the wound surface. Biofilm studies highlighted that the two species, alone or associated, constituted a faster and thicker biofilm in the CWM compared to the BHI medium. The effect of antibiotics on mature or “debrided” biofilm indicated that some of the most clinically used antibiotic such as vancomycin or imipenem were not able to disrupt and reduce the biofilm biomass. The use of a life cell imaging with an in vitro CWM represents a promising tool to study bacterial biofilm and investigate microbial cooperation in a chronic wound context.

This study assessed the clonal diversity, the resistance profile and the virulence potential of Escherichia coli strains isolated from diabetic foot infection (DFI) and diabetic foot osteomyelitis (DFOM). A retrospective single-centre study was conducted on patients diagnosed with E. coli isolated from deep DFI and DFOM at Clinique du Pied Diabétique Gard-Occitanie (France) over a two-year period. Phylogenetic backgrounds, virulence factors (VFs) and antibiotic resistance profiles were determined. Whole-genome analysis of E. coli strains isolated from same patients at different periods were performed. From the two-years study period, 35 E. coli strains isolated from 33 patients were analysed, 73% were isolated from DFOM. The majority of the strains belonged to the virulent B2 and D phylogenetic groups (82%). These isolates exhibited a significant higher average of VFs number than strains belonging to other groups (p &lt, 0.001). papG2 gene was significantly more detected in strains belonging to B2 phylogroup isolated from DFI compared to DFOM (p = 0.003). The most prevalent antibiotic resistance pattern was observed for ampicillin (82%), cotrimoxazole (45%), and ciprofloxacin (33%). The genome analysis of strains isolated at two periods in DFOM showed a decrease of the genome size, and this decrease was more important for the strain isolated at nine months (vs. four months). A shared mutation on the putative acyl-CoA dehydrogenase-encoding gene aidB was observed on both strains. E. coli isolates from DFOM were highly genetically diverse with different pathogenicity traits. Their adaptation in the bone structure could require genome reduction and some important modifications in the balance virulence/resistance of the bacteria.

Background Diabetic foot infections (DFIs) represent a serious threat to public health because of their frequency and the severity of their consequences, i.e. osteomyelitis and amputation. The management of diabetic foot osteomyelitis (DFOM) requires prolonged antibiotic therapy. In Western countries, Gram-positive bacteria are the most commonly encountered pathogens. Objectives This study evaluated the in vitro activity of dalbavancin, a novel lipoglycopeptide with extended half-life, recently marketed in Europe for acute bacterial skin and skin structure infections, on a panel of Gram-positive bacteria responsible for DFOM. Methods Dalbavancin activity was evaluated against a panel of Gram-positive bacterial strains isolated from bone biopsies performed by a trained surgeon among patients with suspected DFOM. MICs were determined using MIC Test Strips (Liofilchem) and confirmed with the EUCAST broth microdilution method. Three other antimicrobial agents (vancomycin, teicoplanin and ceftobiprole) were used as comparators. Results Dalbavancin showed excellent activity against all Gram-positive bacterial strains tested, including one teicoplanin-resistant Staphylococcus epidermidis isolate. With MIC50 and MIC90 values of 0.047 and 0.094 mg/L, respectively, dalbavancin showed the most potent in vitro activity among antimicrobial agents tested. Conclusions With its efficacy, good tolerability and unique pharmacokinetic properties, dalbavancin appears to be a promising treatment for DFOM involving Gram-positive bacteria.

International audience; Foot infections are the main disabling complication in patients with diabetes mellitus. These infections can lead to lower-limb amputation, increasing mortality and decreasing the quality of life. Biofilm formation is an important pathophysiology step in diabetic foot ulcers (DFU)—it plays a main role in the disease progression and chronicity of the lesion, the development of antibiotic resistance, and makes wound healing difficult to treat. The main problem is the difficulty in distinguishing between infection and colonization in DFU. The bacteria present in DFU are organized into functionally equivalent pathogroups that allow for close interactions between the bacteria within the biofilm. Consequently, some bacterial species that alone would be considered non-pathogenic, or incapable of maintaining a chronic infection, could co-aggregate symbiotically in a pathogenic biofilm and act synergistically to cause a chronic infection. In this review, we discuss current knowledge on biofilm formation, its presence in DFU, how the diabetic environment affects biofilm formation and its regulation, and the clinical implications.

International audience; AIM: We evaluated the performance of Unyvero implant and tissue infections system (ITI) application (Curetis) to diagnose Diabetic Foot Osteomyelitis (DFOM). PATIENTS & METHODS: The study was conducted in the Diabetic Foot reference center of N\ⁱmes University Hospital (France) from 1 December 2016 to 31 May 2017. We compared the Unyvero ITI PCR to conventional culture and alternative molecular approaches. RESULTS: A total of 79 patients with DFOM were included: 177 microorganisms were isolated by culture, 146 detected by PCR, resulting in a concordance level of 66.7% (65.0-68.4). Discrepant results were obtained for 45 samples, with 59 microorganisms being detected by PCR only (18 samples) or by culture only (27 samples). CONCLUSION: Unyvero ITI PCR represents an interesting additional diagnosis solution to manage DFOM.

International audience; Objectives: The purpose of this study is to evaluate and compare the effects of two education programs on patients' understanding of the disease, self-efficacy, locus of control, and application of prevention behaviors for foot ulcer. Methods: In four centers that manage patients with diabetes and grade 2 or 3 neuropathy, the first arm of patients (G1 = 53) participated in a "standard" program usually managed in each center, and those in the second arm (G2 = 56) in a "new" program. The patients completed four questionnaires at inclusion (T0) and six months after the education (T1). Occurrence of a new foot ulcer and care behaviors were collected at T1. Z-test was used to compare mean scores for each questionnaire and Fisher's exact test for percentages (p = 0.05). Results: There was no significant difference between groups G1 and G2 in terms of scores for each questionnaire at T0 and T1. Group G2 showed a significant change in score between T0 and T1 for understanding the disease (p = 0.04) and prevention behaviors (p = 0.01). For the sample as a whole (n = 109), there was a significant improvement between T0 and T1 for two questionnaires: understanding of disease (p < 0.01) and declared prevention behaviors (p < 0.01). Patients who reported having relative to participate in care had a significantly higher mean score on prevention behaviors (p < 0.01). Twenty patients had developed one new ulcer since the education (20.2%). Conclusion: This study reinforces the importance of devoting time during education to patients' understanding of the disease and involving relatives to improve foot ulcer prevention behaviors.; Évaluation de deux programmes d'éducation thérapeutique du patient sur la prévention des plaies de pieds diabétiques à risques. Objectif : Le but de cette étude est d'évaluer et de comparer les effets de deux programmes d'éducation sur la compréhension de la maladie par les patients, l'auto efficacité, le locus de contrôle et l'application des comportements de prévention de l'ulcère du pied. Méthode : Dans quatre centres de référence pour les patients atteints de diabète avec une neuropathie de grade 2 ou 3, le premier groupe de patients (G1 = 53) a participé à un programme "standard" habituellement utilisé dans chaque centre, et ceux du deuxième groupe (G2 = 56) à un "nouveau" programme. Les patients ont rempli quatre questionnaires à l'inclusion (T0) et six mois après l'éducation (T1). L'apparition d'un nouvel ulcère du pied et d'autres comportements de prévention ont été notés à T1. Le test Z a été utilisé pour comparer les résultats moyens de chaque questionnaire et le test exact de Fisher pour les pourcentages (p = 0,05). Résultats : Il n'y avait pas de différence significative entre les groupes G1 et G2 concernant les résultats de chaque questionnaire à T0 et T1. Le groupe G2 a montré un changement significatif dans le score entre T0 et T1 pour deux questionnaires : compréhension de la maladie (p

Aims Nasal carriage of Staphylococcus aureus in diabetic patients may be a risk factor for diabetic foot lesion infections. The aims of this study were to compare the genotypic profiles of S. aureus strains isolated from nares and diabetic foot ulcers (DFUs) using microarray technology. Methods Patients were included if they were admitted for diabetic foot infection (DFI) at any of three diabetology departments of Montpellier and Nimes University Hospitals between 1 September 2010 to 30 June 2012. All S. aureus isolates were analyzed using oligonucleotides arrays; S. aureus resistance and virulence genes were determined and each isolate was affiliated to a clonal complex. Results The prevalence of S. aureus nasal carriage among the 276 included patients was 39.5% ( n =109), while 36.6% ( n =101) had S. aureus at both sites (nares and foot wounds) and, of these patients, 65.3% of patients harboured the same strain at both sites. In addition, the spread of the methicillin-resistant S. aureus (MRSA) ST398 clone in DFI and its tropism for bone were also further confirmed. Conclusion These findings appear to provide new arguments in favour of the systematic detection of nasal S. aureus carriage to anticipate the management of DFI.

OBJECTIVE To extend our previous work on evaluating the use of oligonucleotide arrays to discriminate colonization from infection owing to Staphylococcus aureus in diabetic foot ulcers (DFUs). RESEARCH DESIGN AND METHODS Patients admitted to 14 French diabetic foot departments for a DFU were screened for entry into the study. At admission, ulcers were classified based on clinical examination according to the Infectious Diseases Society of America system. Only patients with monomicrobial culture for S. aureus were included. In persons with an uninfected ulcer, a second wound bacterial specimen was obtained 1 month later. Using oligonucleotide arrays, S. aureus resistance and virulence genes were determined, and each isolate was affiliated to a clonal complex (CC). RESULTS S. aureus was initially isolated from 75 uninfected and 120 infected ulcers; 35 were methicillin resistant. A total of 44 (59%) strains from uninfected DFUs belonged to CC5/CC8 clones vs. 6 (5%) from infected DFUs (P < 0.001). During follow-up, 57 (76%) of uninfected DFUs healed or had a favorable outcome; the strain in 49 (86%) of them belonged to CC5/CC8. Conversely, 18 (24%) had a poor outcome but not a single strain belonged to CC5/CC8 clone. Moreover, lukDE was significantly associated with a favorable outcome of the wound. CONCLUSIONS As suggested by our previous study, the use of DNA arrays appears to be a promising technique that might help distinguishing uninfected from infected wounds, predicting ulcer outcome and then contributing to a more adequate use of antibiotics.

Aims/hypothesis In 2003, guidelines for management of diabetic foot infection (DFI) were written by the authors’ team according to the guidelines of the International Working Group on the Diabetic Foot. The effects of implementing these guidelines on the microbiology and costs of infected diabetic foot ulcers were assessed. Methods From 2003 to 2007, potential beneficial effects of implementing these guidelines were assessed by comparison over time of bacteriological data (number of bacterial samples, number of microorganisms isolated in cultures, prevalence of multidrug-resistant organisms [MDRO] and colonising flora), and costs related to use of antimicrobial agents and microbiology laboratory workload. Results The study included 405 consecutive diabetic patients referred to the Diabetic Foot Unit for a suspected DFI. From 2003 to 2007, asignificant decrease was observed in the median number of bacteria species per sample (from 4.1 to 1.6), prevalence of MDRO (35.2% vs 16.3%) and methicillin-resistant Staphylococcus aureus (52.2% vs 18.9%) (p

The Internet has become a major source of health information for consumers. Nevertheless the quality of medical information varies widely and is generally poor. Aim This study aimed to evaluate the quality of information delivered on French-speaking Internet about the diabetic foot. Methods Websites were selected using three popular search engines and introducing “foot + diabetes” and “foot + diabetic” as keywords. Two diabetologists independently evaluated the quality of information using a specially created scoring grid (range 0–52) based on acknowledged and published criteria with items relevant to general characteristics of the site and to information content. One hundred and twenty websites were selected but only 27 were included for analysis. Results Agreement between the two raters was close for global score and site content but lower for site characteristics. Averaged global score ranged from 8 to 44. Only five sites were assessed as very advisable with a score higher than 39; in contrast 18 sites were judged as not advisable at all (score lower than 26). Conclusion This study, the first to be devoted to information about the diabetic foot on the Internet, clearly shows the variability and the general poor quality of information delivered by the great majority of French-speaking websites. Regulation organisms are urgently needed for checking and labelling public oriented health information in order to make the Internet a performing tool for patient information.

Introduction Evaluer l’utilite de tests de PCR automatises, rapides (50 min) pour detecter Staphylococcus aureus (et la methicillinoresistance) dans les plaies et le nez chez le diabetique. Patients et methodes 276 adultes diabetiques (72 % d’hommes, âge median : 68,5 ans), ayant une plaie infectee du pied ont ete inclus du 1/09/10 au 30/03/12 dans 3 centres specialises francais. Apres debridement, un prelevement etait realise par ecouvillonnage de la plaie. Un ecouvillonnage nasal etait egalement effectue. Les ecouvillons a deux tetes etaient soient ensemences sur milieux geloses, soient testes sur systeme GeneXpert ® . Les sensibilites (Se), specificites (Sp), valeurs predictives negatives (VPN) et positives (VPP) de ce systeme ont ete determinees avec la culture comme reference. Resultats 462 bacteries ont ete isolees (1,67 bacteries/prelevement). La prevalence du portage de S. aureus etait de 62,7 % au niveau des pieds et 39,5 % au niveau nasal. 101 (36,6 %) patients etaient porteurs de la bacterie dans les 2 sites. La prevalence des staphylocoques methicillinoresistants (SARM) etait de 17 %. Pour la detection de S. aureus dans les plaies par GeneXpert ® , la Se etait de 100 %, la Sp de 93,2 %, VPN et VPP de 100 % et 95,8 %, respectivement. Pour la detection de S. aureus dans le nez, la Se etait de 100 %, la Sp de 97,0 %, et VPN et VPP de 100 % et 95,6 %, respectivement. Aucune difference n’a ete observee pour la detection des SARM. Conclusion Cette etude montre l’importance de S. aureus dans les plaies du pied et le nez des diabetiques. Les performances du systeme GeneXpert apparaissent excellentes. Il est concevable qu’un tel systeme puisse etre implante dans des centres specialises, permettant une utilisation plus raisonnee des antibiotiques.

Objectif Comme une etude pilote avait precedemment montre la presence d’une population de Staphylococcus aureus colonisante appartenant aux complexes clonaux CC5 et CC8 sur les plaies du pied chez le diabetique, le but de la presente etude a ete d’evaluer la prevalence de ces souches en France. Patients et methodes Les patients adultes diabetiques (type 1 et 2), presentant une plaie du pied (grades 1–4; SPILF 2007) avec S. aureus comme seul pathogene ont ete inclus du 1/04/08 au 30/06/10 dans 12 CHU francais. Tous les patients avec plaie de grade 1 (non infectee) ont eu une consultation de suivi dans le mois suivant au cours de laquelle un 2e prelevement a ete effectue. L’origine clonale des souches a ete detectee par biopuces a ADN (StaphyType96®, Alere). Resultats 195 patients ont ete inclus (71% d’hommes, 75 plaies de grade 1) et 223 souches de S. aureus ont ete isolees dont 35 methicillino-resistantes lors de la consultation inaugurale ou de suivi. A l’inclusion, 44 (59%) souches isolees de plaies de grade 1 appartenaient aux clones CC5/CC8 contre 6 (5%) dans les plaies infectees (grades 2–4) (p Conclusion Cette etude demontre l’existence en France d’une population de S. aureus colonisante presente sur les plaies du pied chez le diabetique. L’identification de ces souches permet de distinguer les colonisations (grade 1) des infections (grades 2–4), predire le devenir de la plaie et devrait contribuer a un meilleur usage des antibiotiques dans la prise en charge des plaies du pied chez le diabetique.

But Evaluer l’equilibre metabolique et les modalites de prise en charge (PEC) des diabetiques hospitalises dans un pole medical a orientation vasculaire et metabolique (10 services). Comparer la PEC dans les services non specialises en diabetologie (NSD) (8 services) a celle des 2 services specialises en diabetologie (SD) du meme pole. Patients et Methodes Enquete prospective transversale sur un jour realisee a l’aide d’un questionnaire standardise rempli par des etudiants hospitaliers prealablement formes. Resultats Sur 363 patients hospitalises, 30 % sont diabetiques dont 55 % dans un service NSD : âge moyen 69 ± 11,9 ans, H/F 55/45, BMI non renseigne dans 27,5 % des cas ; 84 % sont DT2, 78,2 % hypertendus et 61 % insulines a l’entree ; HbA1c > 7 % pour 50 % et > 8 % pour 20,5 % d’entre eux mais non dosee chez 43,3 % des patients NSD vs 11,5 % en SD ; Complications liees au diabete presentes a l’entree non connues chez 41 % des patients NSD contre 11,4 % en SD ; recueil tres incomplet pour la retinopathie et l’antecedent de plaie des pieds : + de 50 % ; recherche des complications pas systematique au cours de l’hospitalisation : ECG peu oublie (seulement 17,2 % NSD et 13,4 % SD), mais nephropathie non recherchee dans 93,3 % des cas NSD vs 8,1 % SD et fond d’œil peu realise (NSD 11,5 % vs SD 83,7 %) ; bilan lipidique effectue dans seulement 43,3 % en services NSD contre 79,7 % en SD. Avis du diabetologue sollicite dans les services NSD que dans 15,7 % des cas bien que 85,5 % de ces patients n’aient pas de suivi specialise. Conclusion Cette etude transversale montre : la forte prevalence de la population diabetique dans nos services de Medecine a orientation vasculaire et metabolique ; la difficulte a evaluer la qualite de la PEC du DS selon les recommandations de l’HAS, meme en milieu hospitalo-universitaire. La non remise en question du traitement du diabete malgre un equilibre glycemique particulierement insuffisant dans une population a haut risque vasculaire. Ces resultats plaident pour la mise en place de structures transversales specialisees intra-hospitalieres capables d’assurer une PEC globale du diabetique.

Introduction L’hypothyroidie concerne 2 % de la population feminine et touche environ 0,3 a 2,5 % des femmes enceintes (hypothyroidie averee 0,3-0,7 %, hypothyroidie fruste 2,2-2,5 %). Elle est definie par une TSH ≥ 2,5mU/l, et peut avoir des repercussions notables sur le deroulement de la grossesse, le developpement fœtal et intellectuel de l’enfant. En effet, des etudes ont montre que le quotient intellectuel d’enfants de 9 ans, nes de meres en hypothyroidie moderee pendant la grossesse etait inferieur a celui d’une population temoin. Il n’existe, pourtant, aucun consensus quant au depistage systematique de l’hypothyroidie en debut de grossesse. Le diabete gestationnel est, par ailleurs, une pathologie frequente de la grossesse puisqu’elle concerne 3 a 6 % des femmes enceintes. Patients et methodes L’objectif de ce travail est d’evaluer la prevalence de l’hypothyroidie et des anticorps anti-thyroperoxydase et anti-thyroglobuline dans une population de femmes presentant un diabete gestationnel. Celui-ci a ete diagnostique a partir de la 24e semaine d’amenorrhee (hyperglycemie provoquee orale 75 ou 100 g de glucose) chez 105 femmes âgees de 23 a 45 ans, hospitalisees dans le service de Maladies metaboliques et Endocriniennes du C.H.U. de Nimes. Etaient exclues les patientes ayant des antecedents de dysthyroidie, les grossesses diabetiques, les grossesses gemellaires. L’hypothyroidie etait definie par une TSH ≥ 2,5mU/l (dosage chimiluminescent immunometrique), avec ou sans anomalies des hormones libres (dosage immunoradiometrique). Resultats Dans cette population, l’hypothyroidie est retrouvee dans 26,67 % des cas, avec une prevalence de positivite des anticorps de 4,76 % dans la population globale et de 2,86 % dans le groupe hypothyroidie. La T4 libre n’est retrouvee basse que chez 3 femmes, dont 2 ayant une TSH normale. Conclusion Malgre la faible positivite des anticorps anti-TPO retrouvee, posant la question du mecanisme physiopathologique, la prevalence de l’hypothyroidie est fortement augmentee en cas de diabete gestationnel, necessitant un controle a plus grande echelle et soulevant a nouveau le debat du depistage de l’hypothyroidie au cours de la grossesse.

Le diabète est une pathologie dont la fréquence ne cesse d’augmenter. Les plaies du pied sont une des complications du diabète, souvent source de retard de prise en charge et de conséquences graves. Depuis le début de l’année 2020, l’épidémie de la Covid-19 a eu des conséquences socio-sanitaires importantes. L’objectif principal de ce travail était d’explorer les raisons d’un adressage tardif à un centre spécialisé, des patients atteints de plaies du pied diabétique. L’objectif secondaire était d’identifier des éléments à risque d’hospitalisation. Matériels et méthodes : étude qualitative avec analyse thématique d’entretiens semi-dirigés de patients ayant des plaies du pied diabétique apparus ou détérioré depuis le 1er janvier 2020. Une première population nécessitant une hospitalisation et une deuxième population prise en charge uniquement par les soins primaires ont été étudiées.Résultats : 21 entretiens ont été réalisés entre août et novembre 2020. L’adressage tardif a été expliqué par plusieurs éléments : la neuropathie diabétique, l’inconscience du risque, l’impact psychologique, l’insouciance du diabète lui-même et la prise en charge dans un centre non spécialisé. L’impact de l’épidémie du Covid-19 a aussi été soulevé par les patients. Le confinement a majoré les délais d’orientation vers les centres spécialisés. Dans la population 2, la prévention et le suivi du diabète ont été plus marqués. Il y a eu moins de comorbidités et de complications liées au diabète.Discussions : les soins primaires jouent un rôle de sentinelle important pour les centres spécialisés pour les patients ayant des plaies du pied diabétique. La télémédecine, les centres spécialisés et les guidelines pour les soins primaires sont autant de solutions permettant de limiter le retard de prise en charge.Conclusion : la prévention est indispensable pour lutter contre le retard de prise en charge. L’information du patient sur la continuité des soins est essentielle en cas de crises socio-sanitaires risquant de majorer ce retard.

L’ostéoarthropathie neurogène diabétique (OAND) est une complication sous-diagnostiquée du diabète, responsable d’une destruction progressive du pied et d’une importante morbi-mortalité. L’objectif de l’étude EPiChar est de réaliser un état des lieux national de sa prise en charge.Matériels et méthodes : il s’agit d’une étude clinique descriptive, multicentrique, recensant chaque patient porteur d’OAND vu en consultation ouhospitalisation entre le 1er janvier et le 31 décembre 2019, dans 31 centres « pied diabétique » franco-belges.Résultats : inclusion de 467 patients (hommes 73,5%), dont 21,6% avec une atteinte bilatérale, soit 568 pieds de Charcot. L’essentiel des patients a un diabète ancien, insuliné, avec forte présence de complications microangiopathiques (96,6%) et d’antécédents podologiques (84%). Plus des 3/4 des OAND sont en phase chronique, avec un chaussage spécifique prescrit dans 81,5% des cas. La place de la chirurgie correctrice des déformations reste faible. En phase aiguë, on retrouve des signes inflammatoires locaux chez 85,7% des patients et un facteur déclenchant dans 41,5% d’entre eux. Les examens d’imagerie (IRM, radiographie standard) sont réalisés dans 90,2% des cas. La décharge du pied (modalités variables) en phase aigüe ou en cas de plaie est faite dans 85,2% des cas. Le médio-pied est la zone la plus touchée. Le taux d’ulcération du pied de Charcot est de 42,6%.Conclusion : le pied de Charcot est une complication complexe du diabète pour laquelle il n’existe actuellement aucun consensus de prise en charge, notamment à la phase aiguë.