If you suffer from diabetes you know how important foot health care is. The reduced circulation in the feet can lead to several problem including eventually amputation. Over 70% of all lower leg and foot removal surgeries in the US are performed on diabetics due to the complications associated with the disease.

Choosing the correct foot wear can go a long way toward keeping your feet as healthy as possible. There are several things you should look for when choosing diabetic shoes and all of them are important.

• Natural material. Your feet need to be able to breath to get the moisture away from the skin. Most man made materials do not allow this but shoes made with materials from nature will help to keep your feet dry.
• Proper fit. Fit is very important to diabetics because any irritation to the foot can easily result in a sore or blister due to the poor circulation. These sores can easily grow into ulcers and become infected. Infection is usually what necessitates foot removal.
• Removable sole inserts. Not only will these make the soles of your feet more comfortable but they also will allow for more wicking of the moisture away from the foot. Several different styles of inserts are available including ones that also limit foot odor.
• Adjustable closures. Your feet are going to swell at times so it is very important that you be able to adjust the shoes to fit this reality. Hook and loop closures work very well to compensate for foot swelling.

Taking care of your feet is one of the most important aspects in the treatment of diabetes. The first level of defense is to do everything including control of diet and use of medicine to keep your blood sugar levels correct. The next is to choose diabetic shoes that are designed to help protect the feet.

A comparison of the long-term effect of four oral antidiabetes treatment regimens shows that therapy based on the combination of pioglitazone and metformin is associated with the greatest improvement in insulin resistance parameters.

Insulin resistance, together with beta-cell dysfunction, leads to the appearance and gradual progression of Type 2 diabetes, and is an independent predictor for cardiovascular disease in these patients.

In the first clinical trial directly comparing the insulin-sensitizing effects of different oral antidiabetes drug regimens, Giuseppe Derosa (University of Pavia, Italy) and co-workers randomly assigned 272 overweight, treatment-naïve patients with Type 2 diabetes and poor glycemic control to receive one of four treatment regimens for 15 months.

The compared treatments were metformin 1000 mg/day alone, pioglitazone 15 mg/day alone, pioglitazone/metformin 15 mg/850 mg/day, and glimepiride/metformin 2 mg/850 mg/day.

Patients received instruction on dietary intake and were encouraged to increase physical activity.

Insulin resistance was determined at baseline, and after 3 and 15 months by euglycemic hyperinsulinemic clamp, which measures the amount of glucose necessary to compensate for an increased insulin level without causing hypoglycemia. Parameters studied included fasting plasma insulin (FPI), postprandial plasma insulin (PPI), glucose infusion rate (GIR), and total glucose requirement (TGR).

Presenting the results in the journal Metabolism Clinical and Experimental, the authors report that, with the exception of PPI, insulin resistance-related parameters significantly improved in all the groups compared with baseline, but more so with pioglitazone/metformin. Mean improvements in this group were -30% for FPI, 52.6% for GIR, and 29% for TGR, compared with a mean improvement in the other groups of -10%, 23%, and 12%, respectively.

All treatments except the glimepiride-based regimen also achieved a significant reduction in PPI. In the pioglitazone/metformin-treated group, PPI decreased by 33% versus baseline, whereas it increased by 9.6% in the glimepiride/metformin group.

Glycated hemoglobin (HbA1c) decreased in all groups, but the greatest reduction was observed in the pioglitazone/metformin group. Decreases in fasting plasma glucose and postprandial plasma glucose were also greatest with this regimen.

An increase in body mass index (BMI) was observed in the groups treated with pioglitazone alone and with glimepiride/metformin at 15 months, whereas no BMI changes were observed in the other two groups compared with the baseline.

“Pioglitazone/metformin-based therapeutic control is associated with the most quantitatively relevant improvement in insulin resistance-related parameters, whereas the sulfonylurea-metformin-including protocol has less relevant effects,” conclude the authors.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract

Results from a meta-analysis show that intensive glucose control reduces the risk for cardiovascular disease (CVD) in individuals with Type 2 diabetes to a greater extent than conventional control.

However, the risk for severe hypoglycemia in the intensively treated group was significantly higher than for those treated conventionally.

“Clinical trials have shown that intensive glucose control reduces the risk for microvascular complications among patients with Type 2 diabetes, but its effect on CVD, including coronary heart disease (CHD), stroke, and peripheral arterial disease, is uncertain,” say Tanika Kelly (Tulane University School of Public Health and Tropical Medicine, New Orleans, Los Angeles, USA) and colleagues.

The team selected five suitable trials with a total of 27,802 participants aged between 53 and 66 years.

Inclusion criteria for the studies used in the analysis were being a randomized controlled trial, comparing intensive (glycated hemoglobin [HbA1c] target of below 6.5%) with conventional treatment (usually HbA1c target of 7??”9%) for Type 2 diabetes, having clinical CVD as a primary endpoint, and including 500 participants or more. Study duration ranged from 3.4 to 10.7 years.

The researchers found that, compared with conventional control, intensive glucose control significantly reduced the relative risk for CVD by 30%, but did not reduce the risk for cardiovascular death or all-cause mortality.

In contrast, the relative risk for severe hypoglycemia was 2.03-fold higher in the intensive versus the conventional therapy group.

“The results of this meta-analysis provide some evidence for a beneficial effect of intensive glucose control on CVD, particularly on nonfatal myocardial infarction, but not on cardiovascular deaths and all-cause mortality in patients with Type 2 diabetes,” conclude Kelly et al in the Annals of Internal Medicine.

“Furthermore, our results emphasize severe hypoglycemia as an important adverse effect of intensive glucose control.”

They suggest that “health care providers should focus their efforts on combining elements of lifestyle modification, glucose control that minimizes hypoglycemia, blood pressure reduction, and lipid lowering to optimally curtail the risk for CVD in patients with Type 2 diabetes.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Free abstract