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全科医生在糖尿病足管理中作用的研究进展
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Abstract:
糖尿病足是糖尿病患者中常见且严重的并发症，对患者的生存质量和医疗系统造成重大负担。全科医生在糖尿病足的早期识别、筛查及干预中扮演着至关重要的角色。本文全面分析了全科医生在糖尿病足预防、早期诊断及长期管理策略中的干预措施，旨在揭示其在提升患者健康结果中的核心作用。详细分析了个性化治疗方案和多学科协作模式的有效性，指出定期随访和风险分层评估可以显著减少溃疡、感染及截肢等并发症的发生。同时，探讨了新兴筛查工具，特别是人工智能辅助诊断技术，在糖尿病足管理中的应用前景。全科医生是基层医疗中糖尿病足管理的核心力量，通过个性化的干预措施和多学科协作可以提升糖尿病足的管理效果。
Diabetes foot is a common and serious complication in diabetes patients, which causes a heavy burden on the quality of life and medical system of patients. General practitioners play a pivotal role in the early recognition, screening, and intervention of diabetic foot. This paper comprehensively analyzes the intervention measures taken by general practitioners in the prevention, early diagnosis, and long-term management strategies of diabetic foot, aiming to reveal its core role in improving patient health outcomes. A detailed analysis was conducted on the effectiveness of personalized treatment plans and multidisciplinary collaboration models, and it was pointed out that regular follow-up and risk stratification assessments can significantly reduce the occurrence of complications such as ulcers, infections, and amputations. At the same time, the application prospect of emerging screening tools, especially artificial intelligence assisted diagnosis technology, in the management of diabetes foot was discussed. General practitioners are the core force of diabetes foot management in primary care. Through personalized intervention measures and multidisciplinary cooperation, the management effect of diabetes foot can be improved.
| [1] | Hüsers, J., Hafer, G., Heggemann, J., Wiemeyer, S., John, S.M. and Hübner, U. (2020) Predicting the Amputation Risk for Patients with Diabetic Foot Ulceration—A Bayesian Decision Support Tool. BMC Medical Informatics and Decision Making, 20, Article No. 200. https://doi.org/10.1186/s12911-020-01195-x |
| [2] | 徐旭英. 《中国糖尿病足防治指南2019》解读[J]. 中国临床医生杂志, 2023, 51(4): 394-397. |
| [3] | 《多学科合作下糖尿病足防治专家共识(2020版)》编写组. 多学科合作下糖尿病足防治专家共识(2020版)精华版(II) [J]. 中华烧伤杂志, 2020, 36(9): 767-785. |
| [4] | Wang, X., Yuan, C., Xu, B. and Yu, Z. (2022) Diabetic Foot Ulcers: Classification, Risk Factors and Management. World Journal of Diabetes, 13, 1049-1065. https://doi.org/10.4239/wjd.v13.i12.1049 |
| [5] | Raja, J.M., Maturana, M.A., Kayali, S., Khouzam, A. and Efeovbokhan, N. (2023) Diabetic Foot Ulcer: A Comprehensive Review of Pathophysiology and Management Modalities. World Journal of Clinical Cases, 11, 1684-1693. https://doi.org/10.12998/wjcc.v11.i8.1684 |
| [6] | Deng, H., Li, B., Shen, Q., Zhang, C., Kuang, L., Chen, R., et al. (2023) Mechanisms of Diabetic Foot Ulceration: A Review. Journal of Diabetes, 15, 299-312. https://doi.org/10.1111/1753-0407.13372 |
| [7] | Frykberg, R.G. (2002) Diabetic Foot Ulcers: Pathogenesis and Management. American Academy of Family Physicians, 66, 1655-1663. |
| [8] | van Netten, J.J., Bus, S.A., Apelqvist, J., Lipsky, B.A., Hinchliffe, R.J., Game, F., et al. (2020) Definitions and Criteria for Diabetic Foot Disease. Diabetes/Metabolism Research and Reviews, 36, e3268. https://doi.org/10.1002/dmrr.3268 |
| [9] | Yap, M.H., Cassidy, B., Pappachan, J.M., O’Shea, C., Gillespie, D. and Reeves, N.D. (2021) Analysis towards Classification of Infection and Ischaemia of Diabetic Foot Ulcers. 2021 IEEE EMBS International Conference on Biomedical and Health Informatics (BHI), Athens, 27-30 July 2021, 1-4. https://doi.org/10.1109/bhi50953.2021.9508563 |
| [10] | Pappachan, J.M., Cassidy, B., Fernandez, C.J., Chandrabalan, V. and Yap, M.H. (2022) The Role of Artificial Intelligence Technology in the Care of Diabetic Foot Ulcers: The Past, the Present, and the Future. World Journal of Diabetes, 13, 1131-1139. https://doi.org/10.4239/wjd.v13.i12.1131 |
| [11] | Huynh, Q.T., Nguyen, P.H., Le, H.X., Ngo, L.T., Trinh, N., Tran, M.T., et al. (2022) Automatic Acne Object Detection and Acne Severity Grading Using Smartphone Images and Artificial Intelligence. Diagnostics, 12, Article 1879. https://doi.org/10.3390/diagnostics12081879 |
| [12] | Pemayun, T.G.D. and Naibaho, R.M. (2017) Clinical Profile and Outcome of Diabetic Foot Ulcer, a View from Tertiary Care Hospital in Semarang, Indonesia. Diabetic Foot & Ankle, 8, Article 1312974. https://doi.org/10.1080/2000625X.2017.1312974 |
| [13] | Meloni, M., Izzo, V., Giurato, L., Lázaro-Martínez, J.L. and Uccioli, L. (2020) Prevalence, Clinical Aspects and Outcomes in a Large Cohort of Persons with Diabetic Foot Disease: Comparison between Neuropathic and Ischemic Ulcers. Journal of Clinical Medicine, 9, Article 1780. https://doi.org/10.3390/jcm9061780 |
| [14] | Peng, B., Min, R., Liao, Y. and Yu, A. (2021) Development of Predictive Nomograms for Clinical Use to Quantify the Risk of Amputation in Patients with Diabetic Foot Ulcer. Journal of Diabetes Research, 2021, Article 6621035. https://doi.org/10.1155/2021/6621035 |
| [15] | Pérez-Panero, A.J., Ruiz-Muñoz, M., Cuesta-Vargas, A.I. and Gónzalez-Sánchez, M. (2019) Prevention, Assessment, Diagnosis and Management of Diabetic Foot Based on Clinical Practice Guidelines. Medicine, 98, e16877. https://doi.org/10.1097/md.0000000000016877 |
| [16] | Schaper, N.C., van Netten, J.J., Apelqvist, J., Bus, S.A., Hinchliffe, R.J. and Lipsky, B.A. (2020) Practical Guidelines on the Prevention and Management of Diabetic Foot Disease (IWGDF 2019 Update). Diabetes/Metabolism Research and Reviews, 36, e3266. https://doi.org/10.1002/dmrr.3266 |
| [17] | Sharma, R., Sharma, S.K., Mudgal, S.K., Jelly, P. and Thakur, K. (2021) Efficacy of Hyperbaric Oxygen Therapy for Diabetic Foot Ulcer, a Systematic Review and Meta-Analysis of Controlled Clinical Trials. Scientific Reports, 11, Article No. 2189. https://doi.org/10.1038/s41598-021-81886-1 |
| [18] | Pasek, J., Szajkowski, S., Oleś, P. and Cieślar, G. (2022) Local Hyperbaric Oxygen Therapy in the Treatment of Diabetic Foot Ulcers. International Journal of Environmental Research and Public Health, 19, Article 10548. https://doi.org/10.3390/ijerph191710548 |
| [19] | Najafi, B., Reeves, N.D. and Armstrong, D.G. (2020) Leveraging Smart Technologies to Improve the Management of Diabetic Foot Ulcers and Extend Ulcer‐Free Days in Remission. Diabetes/Metabolism Research and Reviews, 36, e3239. https://doi.org/10.1002/dmrr.3239 |
| [20] | Meloni, M., Lazaro-Martínez, J.L., Ahluwalia, R., Bouillet, B., Izzo, V., Di Venanzio, M., et al. (2021) Effectiveness of Fast-Track Pathway for Diabetic Foot Ulcerations. Acta Diabetologica, 58, 1351-1358. https://doi.org/10.1007/s00592-021-01721-x |
| [21] | 费秀文, 董爱梅, 郭晓蕙, 等. 社区医务人员对糖尿病足筛查认识的问卷调查[J]. 中华全科医师杂志, 2020, 19(2): 164-165. |
| [22] | Vileikyte, L., Pouwer, F. and Gonzalez, J.S. (2019) Psychosocial Research in the Diabetic Foot: Are We Making Progress? Diabetes/Metabolism Research and Reviews, 36, e3257. https://doi.org/10.1002/dmrr.3257 |
| [23] | Cereda, E., Veronese, N. and Caccialanza, R. (2023) Nutritional Therapy in Chronic Wound Management for Older Adults. Current Opinion in Clinical Nutrition & Metabolic Care, 27, 3-8. https://doi.org/10.1097/mco.0000000000000990 |
