Wednesday, June 7, 2017

Did you know? Future trends for Diabetes in 2030

The article, “Diabetes 2030,” illustrates that diabetes presents a major health crisis in terms of prevalence, morbidity and costs. Insights from the updated projections show that the crisis will worsen significantly over the next 15 years.  There are several reasons cited for the worsening trend, including: 1. An aging population that is living longer, 2. The significant decline in the incidence of deaths caused by diabetes, which implies that more diabetic patients present with significant chronic co-morbidities, 3. The increasing population of African American and Hispanic Americans who are at a higher risk of diabetes, 4. Dramatic increase in type 2 diabetes in children and adolescents, and 5. Increasing obesity may lead to increasing diabetes.

Health care leaders should understand the importance of identifying adults with prediabetes.  Health care leaders should also focus on education and awareness, as 1 in 4 Americans do not know that they have prediabetes and it can lead to life threatening complications.  There is also a huge gap between a recommended guideline and current practice. A 2014 study by Li et al found that only 6.8% of privately insured, newly diagnosed adults participated in Diabetes Self – Management Education and Training within the first year after diagnosis, even though it was free and strongly recommended. The cost of diabetes will increase by 53% ($408 billion to $622 billion) by 2030. Aggressive efforts at local, state and federal levels in prevention will be needed to significantly reduce the diabetes epidemic by 2030. 

The diabetes epidemic can be prevented using a “population wide” approach that addresses health promotion, obesity prevention, and creates a physical, cultural, and psychological environment that supports healthy living naturally.


“Diabetes 2030: Insights from Yesterday, Today and Future Trends” By Rowley MD et al, Population Health Management, Volume 20, Number 1, 2017.

Tuesday, May 12, 2015

Wound Measurement Techniques: Comparing the Use of Ruler Method, 2D Imaging and 3D Scanner


The statistics on the growing number of non-healing wounds is alarming. In the United States, chronic wounds affect 6.5 million patients. An estimated US $25 billion is spent annually on treatment of chronic wounds and the burden is rapidly growing due to increasing health care costs, an aging population and a sharp rise in the incidence of diabetes and obesity worldwide.1 Accurate wound measurement techniques will help health care personnel to monitor the wounds which will indirectly help improving care.7,9 The clinical practice of measuring wounds has not improved even today.2,3 A common method like the ruler method to measure wounds has poor interrater and intrarater reliability.2,3 Measuring the greatest length by the greatest width perpendicular to the greatest length, the perpendicular method, is more valid and reliable than other ruler based methods.2 Another common method like acetate tracing is more accurate than the ruler method but still has its disadvantages. These common measurement techniques are time consuming with variable inaccuracies. In this study, volumetric measurements taken with a non-contact 3-D scanner are benchmarked against the common ruler method, acetate grid tracing, and 2-D image planimetry volumetric measurement technique. A liquid volumetric fill method is used as the control volume. Results support the hypothesis that the 3-D scanner consistently shows accurate volumetric measurements in comparison to standard volumetric measurements obtained by the waterfill technique (average difference of 11%). The 3-D scanner measurement technique was found more reliable and valid compared to other three techniques, the ruler method (average difference of 75%), acetate grid tracing (average difference of 41%), and 2D planimetric measurements (average difference of 52%). Acetate tracing showed more accurate measurements compared to the ruler method (average difference of 41% (acetate tracing) compared to 75% (ruler method)). Improving the accuracy in measuring chronic wounds might improve overall care of patients with non-healing wounds. This study consistently shows that the 3-D scanner is a more accurate, quicker, and safer method for measuring wounds.

Friday, April 3, 2015

Hyperbaric Oxygen Therapy: Difference between Efficacy and Effectiveness

Hyperbaric oxygen therapy for diabetic wounds.

 Liu showed meta-analysis of 13 trials including 7 prospective randomized trials of 624 patients showing effectiveness.

 Liu R, Li L, Yang M, Boden, Yang G. Systematic review of the effectiveness of hyperbaric
oxygen in the management of chronic diabetic foot ulcers. Mayo Clin Proc.2013;88(2):167-175.

The UHMS Quality, Utilization, Authorization and Reimbursement Committee response trying to explain the difference in “efficacy” and “effectiveness” is at Jeannie Le M.D. Interpretation of the study “Lack of effectiveness of hyperbaric oxygen therapy for the treatment of diabetic foot ulcer and the prevention of amputation”

Sunday, January 18, 2015

Can we use commercially available less expensive infrared thermometers to measure skin surface temperature associated with deep and surrounding wound infection?.

Validation of Commercially Available Infrared Thermometers for Measuring Skin Surface Temperature Associated with Deep and Surrounding Wound Infection

Mufti, Asfandyar BMSc; Coutts, Patricia RN; Sibbald, R. Gary BSc, MD, MEd, FRCPC(Med)(Derm), MACP, FAAD, MAPWCA, DSc(Hons)Advances in Skin & Wound Care:January 2015 - Volume 28 - Issue 1 - p 11-16

doi: 10.1097/01.ASW.0000459039.81701.b2
Features: Original Investigation

At present time there are several shuttle signs which help us identify wound infection( i,e friable spongy granulation tissue, delayed wound healing, Persistent drainage and evidence of wound pain.) Authors of this article suggest that using less expensive industrial grade non contact infrared thermometers might be useful along with other signs may be associated with deep and surrounding wound infections. This could be very helpful clinically in wound care practice if validated further by more evidence based data. 

Wound Care Needs Awareness and Advocacy

Wound Care Needs Awareness and Advocacy