Diabetes and wound or fracture healing

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How does diabetes affect short and long term soft tissue / wound and bony healing?

Top papers identified

Diabetes and its effects on wound healing.
Source: Nursing standard 2011; vol. 25 (no. 45); p. 41-47
Publication Date: 2011
Author(s): Sharp, Ailsa; Clark, Jane

Available in full text at Nursing Standard –  from ProQuest

Available in full text at Nursing Standard –  from EBSCOhost

Abstract:This article discusses the reasons why wounds in people with diabetes take longer to heal and are more susceptible to complications. The physiology of the wound healing process, and how this is affected by diabetes, is outlined. The article also explains why wounds in patients with diabetes are more prone to infection and discusses preventive measures.

Diabetes and Its Effect on Bone and Fracture Healing.
Source: Current osteoporosis reports; Oct 2015; vol. 13 (no. 5); p. 327-335
Publication Date: Oct 2015
Author(s): Jiao, Hongli; Xiao, E; Graves, Dana T

Available in full text at Current Osteoporosis Reports –  from EBSCOhost

Abstract:Diabetes mellitus is a metabolic disorder that increases fracture risk, interferes with bone formation, and impairs fracture healing. Type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) both increase fracture risk and have several common features that affect the bone including hyperglycemia and increased advanced glycation end product (AGE) formation, reactive oxygen species (ROS) generation, and inflammation. These factors affect both osteoblasts and osteoclasts leading to increased osteoclasts and reduced numbers of osteoblasts and bone formation. In addition to fracture healing, T1DM and T2DM impair bone formation under conditions of perturbation such as bacteria-induced periodontal bone loss by increasing osteoblast apoptosis and reducing expression of factors that stimulate osteoblasts such as BMPs and growth factors.

Cellular and molecular basis of wound healing in diabetes.
Source: The Journal of clinical investigation; May 2007; vol. 117 (no. 5); p. 1219-1222
Publication Date: May 2007
Author(s): Brem, Harold; Tomic-Canic, Marjana

Available in full text at Journal of Clinical Investigation –  from ProQuest

Available in full text at Journal of Clinical Investigation –  from EBSCOhost

Abstract:Diabetic foot ulcers (DFUs), a leading cause of amputations, affect 15% of people with diabetes. A series of multiple mechanisms, including decreased cell and growth factor response, lead to diminished peripheral blood flow and decreased local angiogenesis, all of which can contribute to lack of healing in persons with DFUs. In this issue of the JCI, Gallagher and colleagues demonstrate that in diabetic mice, hyperoxia enhances the mobilization of circulating endothelial progenitor cells (EPCs) from the bone marrow to the peripheral circulation (see the related article beginning on page 1249). Local injection of the chemokine stromal cell-derived factor-1alpha then recruits these EPCs to the cutaneous wound site, resulting in accelerated wound healing. Thus, Gallagher et al. have identified novel potential targets for therapeutic intervention in diabetic wound healing.

Diabetes and fracture healing: the skeletal effects of diabetic drugs.
Source: Expert opinion on drug safety; Mar 2012; vol. 11 (no. 2); p. 215-220
Publication Date: Mar 2012
Author(s): Simpson, Christopher M; Calori, Giorgio M; Giannoudis, Peter V
Abstract:Over 39,000 diabetic patients are surgically treated for trauma and orthopaedic injuries annually in the UK, yet the effects of diabetic medications on the skeletal system is an under researched and under acknowledged field. This review covers all English language novel experimental data reports investigating the effects of the main classes of diabetic drugs on the skeletal system, specifically their effects on fracture healing, located through the literature search engines Medline and Web of Science. Post-surgical gylcaemic control is paramount in insulin-controlled type 1 diabetic patients. Data on pharmacological control compounds used in type 2 diabetes are limited. Reports to date indicate thiazolidinediones to exert anti-osteogenic effects, in contrast to the observed osteogenic effects of biguanides. Ongoing research is desirable to guide future clinical recommendations.

The Pathobiology of Diabetes Mellitus in Bone Metabolism, Fracture Healing, and Complications.
Source: American journal of orthopedics (Belle Mead, N.J.); Oct 2015; vol. 44 (no. 10); p. 453-457
Publication Date: Oct 2015
Publication Type(s): Journal Article Review
Author(s): Forslund, Johan M; Archdeacon, Michael T
Abstract:Complications and inferior outcomes of fractures in the setting of diabetes mellitus (DM) are well documented. The incidence of DM is increasing rapidly, particularly in an aging and obese population. Thus, the combination of DM and fracture is becoming a serious health problem worldwide. As many fractures are relatively uncomplicated in the healthy patient population, a concerted effort to improve outcomes of fractures in patients with DM is warranted. In this article, we review relevant studies and examine the pathobiological mechanisms influencing fracture outcomes, including complications related to bone and soft-tissue healing, and infection.


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