Cultura

Pharmacist-Led Interventions For Improving Adherence And Reducing Complications In Diabetes Mellitus: Evidence From Recent Literature

VOLUME 21, 2024

The Role of Targeted Infra-popliteal Endovascular Angioplasty to Treat Diabetic Foot Ulcers Using the Angiosome Model: A Systematic Review

VOLUME 6, 2023

Ashwaq Mohamed Shiqdar, Gharam Jalal Fairaq, Ghaida Hilal Aljazaeri, Safaa Sameer Magliah, Lujain Aimen Andargiri, Nada Naif Alotaibi
Rakhaa Mousa Khateeb, Aishah Siraj Sumayln, Nouf Akash Almatrafi, Shaden Mutleb Suliman Alnafisah, Sultan Mohammed Alanazi

Abstract

Diabetes mellitus is one of the most prevalent chronic diseases worldwide and represents a growing public health challenge with substantial clinical and economic consequences. According to the International Diabetes Federation, more than 537 million adults are currently living with diabetes globally, and this number is projected to increase significantly over the coming decades. Diabetes is associated with a wide range of microvascular and macrovascular complications, including cardiovascular disease, nephropathy, neuropathy, and retinopathy, making it a leading cause of morbidity, mortality, and reduced quality of life worldwide (IDF, 2023).Medication adherence is a cornerstone of effective diabetes management; however, poor adherence remains highly prevalent among patients with diabetes. Evidence suggests that approximately 30–50% of patients do not take their antidiabetic medications as prescribed. Suboptimal adherence is strongly associated with poor glycemic control, elevated HbA1c levels, increased risk of acute and chronic complications, and higher rates of hospitalization. The American Diabetes Association emphasizes that improving adherence to pharmacotherapy is essential for achieving optimal therapeutic outcomes and preventing long-term complications in individuals with diabetes (ADA, 2024).

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Erin Saricilar
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.

Abstract

Atherosclerotic disease significantly impacts patients with type 2 diabetes, who often present with recalcitrant peripheral ulcers. The angiosome model of the foot presents an opportunity to perform direct angiosome-targeted endovascular interventions to maximise both wound healing and limb salvage. A systematic review was performed, with 17 studies included in the final review. Below-the-knee endovascular interventions present significant technical challenges, with technical success depending on the length of lesion being treated and the number of angiosomes that require treatment. Wound healing was significantly improved with direct angiosome-targeted angioplasty, as was limb salvage, with a significant increase in survival without major amputation. Indirect angioplasty, where the intervention is applied to collateral vessels to the angiosomes, yielded similar results to direct angiosome-targeted angioplasty. Applying the angiosome model of the foot in direct angiosome-targeted angioplasty improves outcomes for patients with recalcitrant diabetic foot ulcers in terms of primary wound healing, mean time for complete wound healing and major amputation-free survival.
Keywords : Diabetic foot ulcer, angiosome, angioplasty