title: In-hospital metabolic regulation in patients with a diabetic foot ulcer: is it worthwhile?
abstract: It is well established that hyperglycaemia is associated with many negative cardiovascular and immunological effects. Because of the high prevalence of underlying vascular disease along with associated infection, patients with diabetic foot ulcers are especially vulnerable to these adverse consequences. While studies consistently demonstrate worse outcomes in the setting of hyperglycaemia during hospitalization, multiple trials examining the effects of intensive glycaemic control reveal mixed results. In particular, effects on mortality are varied, and although there may be some benefit in the setting of infection, hypoglycaemia is a concern when glucose levels are treated down to the normoglycaemic range. Therefore, although metabolic regulation is worthwhile theoretically, the optimal intensity of control is unclear. There is a need for future research to clarify the benefits and risks associated with strict metabolic control in patients with diabetic foot ulceration. In the interim recommendations from international guidelines should be followed; these advise pre-meal glucose targets of <7.8 mmol/L and random targets of <10.0 mmol/L in general medical and surgical settings.
authors.affiliation: Galway University Hospitals and National University of Ireland Galway, Galway, Ireland.
authors.forename: Aoife M
authors.initials: AM
authors.lastname: Egan
authors.affiliation: Galway University Hospitals and National University of Ireland Galway, Galway, Ireland.
authors.forename: Sean F
authors.initials: SF
authors.lastname: Dinneen
mesh_terms: D003131:Combined Modality Therapy / Q000009:adverse effects / Q000639:trends; D003226:Congresses as Topic; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000150:complications / Q000503:physiopathology; D017719:Diabetic Foot / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D003929:Diabetic Neuropathies / Q000150:complications / Q000503:physiopathology; D019317:Evidence-Based Medicine; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000139:chemically induced / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D007362:Intensive Care Units; D057285:Precision Medicine; D012720:Severity of Illness Index
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: diabetic foot; glucose control; hospitalization; metabolic control; ulceration