Helping diabetics keep their limbs

Worldwide, an amputation is performed every 30 seconds on a person with diabetes. Right now researchers are testing a new way to improve circulation and save limbs with a patient's own cells.

Claudell Jones is diabetic. So when he started feeling pain in his foot he got help fast. He knew his high blood sugar raised his risk for a serious infection.

"More than likely it would have spread and instead of losing the toe, I would have lost the whole leg," says Jones.

Nerve damage and poor circulation in diabetics' feet can lead to ulcers. If not treated the toe, foot, or even part of the leg may have to be amputated. Claudell was lucky. Doctors were able to improve his circulation with surgery. But every year tens of thousands of diabetics lose limbs.

Doctor Eric Choi is Director of Temple's Limb Salvage Center. He's testing a new procedure that would give patients another option to save a foot, or leg.

"In those patients where we cannot do surgery to restore blood flow, we actually try and see if we can improve the flow by creating new blood vessels," explains Dr. Choi.

It's called angiogenesis.

Choi and his colleagues are testing a therapy that prompts the body to re-grow blood vessels. Doctors extract bone marrow from a patient's hip.

The marrow is stimulated to produce new cells. Those cells are re-injected into patients, and create brand new vessels needed to improve blood flow. Choi says the earlier patients seek treatment, the better the outcome.

"If we can help them early, we don't have to have 150-thousand patients have foot or leg amputations," says Dr. Choi.

A new procedure that could help diabetics like Claudell keep their limbs and quality of life.

Doctor Choi says angiogenesis may increase the risk of developing cancer, so it may not be an option for all patients.


REPORT: MB #3474
BACKGROUND: Diabetes affects 25.8 million people of all ages. Diabetes complications include nerve damage and poor blood circulation. These problems make the feet vulnerable to skin sores (ulcers) that can worsen quickly and are difficult to treat. Proper diabetes management and careful foot care can help prevent foot ulcers. When foot ulcers do develop, it's important to get prompt care. A non-healing ulcer that causes severe damage to tissues and bone may require surgical removal (amputation) of a toe, foot or part of a leg. (Source: Mayo Clinic)

CONTROLLING DIABETES: Nerve damage or neuropathy is a common complication of diabetes, especially among people who have had the disease for many years. Poor control of diabetes, such as prolonged high blood sugar, low insulin levels, and high blood pressure, are believed to be major contributors to diabetes-related nerve damage.
Recommendations for diabetic people from the CDC's National Diabetes Education Program include:
* Wash your feet every day, keep feet soft with lotion or petroleum jelly, smooth corns and calluses gently, and trim toenails frequently
* Wear shoes and socks at all times to minimize the risk of injury.
* Protect feet from extreme heat and cold
* Remain active and do other things to promote blood flow to feet
* Discuss foot care with your doctor (Source: CDC)

HELPING SAVE LIMBS: Temple University Health System we will be the first hospital in the region to participate in a trial called REVIVE - which involves injecting enhanced bone marrow into a patient's leg in order to promote the growth of new blood vessels. This approach is called therapeutic angiogenesis, and the hope is that the new blood vessels will improve blood flow in the leg.
"By stimulating the bone marrow, there will be more of these cells that can grow new blood vessels that are available, and in many cases, the body knows exactly what it needs to do when there is a problem," Dr. Eric Choi, MD, FACS, Chief of Vascular Surgery, told Ivanhoe.

Jennie Wong, RN, CCRP
Temple University
(215) 707-5340

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