Dentists Can Identify People with Undiagnosed Diabetes

July 20th, 2011


ScienceDaily (2011-07-18) -- Dental visits represent a chance to intervene in the diabetes epidemic by identifying individuals with diabetes or pre-diabetes who are unaware of their condition, according to a new study.

In a study, Identification of Unrecognized Diabetes and Pre-diabetes in a Dental Setting, published in the July 2011 issue of the Journal of Dental Research, researchers at Columbia University College of Dental Medicine found that dental visits represented a chance to intervene in the diabetes epidemic by identifying individuals with diabetes or pre-diabetes who are unaware of their condition.

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Maggot Therapy for Diabetic Ulcers

September 28th, 2011

diabetic ulcer

One of the complications of diabetes can be ulcerated wounds that won't heal, particularly on the feet. This is because diabetes causes nerve damage and impairs blood flow and circulation to the extremities. About 1 in 5 diabetics who seek hospital treatment do so because of foot problems, and diabetes is one of the leading causes of lower limb amputations worldwide.

The medical removal of dead or infected tissue from wounds such as diabetic ulcers is called debridement. Doctors typically use scalpels, high pressure fluid, or tissue-dissolving enzymes for the procedure. A less known procedure is maggot debridement therapy, or MDT.

MDT is also referred to as maggot therapy, or by the slightly less disturbing term "larva therapy". The therapy employs the use of live maggots (fly larvae hatched from eggs). These are no ordinary maggots, but FDA-approved, medical grade, phaenicia sericata (blow fly) larvae, available only by prescription.

Medical grade maggots do not feed on or bury into healthy tissue, but dissolve and consume only dead and diseased tissue. They also fight infection by killing bacteria. The maggots are so small when applied that they can not even be felt within the wound, although some patients feel pain when the maggots become bigger (after 24 to 36 hours). Once the maggots are removed, the pain ceases.

According to the Wound Care Information Network: "Maggots do not bite. They do not have teeth. They do have modified mandibles though, called mouthhooks, and they have some rough bumps around their body which scratch and poke the dead tissue, one of the mechanisms that debrides the wound. It is similar to a surgeon's rasper, but on a microscopic scale."

The maggots are held in place over the wound with a mesh-like bandage that allows air in and the wound to drain. Once the maggots have fed, they are ready to leave the wound, and many will bury themselves in the dressing for easy removal. Others can be wiped off with a damp piece of gauze. Any "stragglers" will leave the wound and burry themselves in a fresh bandage within 24 hours.

The use of maggots in medicine began centuries ago, when military doctors noticed that soldiers whose wounds had become infected with maggots healed better. During the 1920s, Dr. William Baer refined the use of medicinal maggots, selecting certain species that fed only on dead tissue, which he raised in the laboratory and used to treat soft tissue infections in children.

MGT became widespread in the 1930s, but fell out of favor in the 1940s with the advent of new antibiotics and improved surgical techniques. In 1989, clinical studies determined that maggot therapy was a safe and effective treatment, and it was recommended not as a therapy of last resort, but as a second or third line of treatment for non-healing wounds. Today, thousands of physicians from over 20 countries are routinely employing maggot therapy. Maggot therapy has been successfully used on wounds infected with the antibiotic resistant MRSA "superbug".

Many argue that no one wants live maggots in and on their body. The Wound Care Information Network retorts: "What patients do not want is a stinking, draining wound. What patients do not want is to lose their foot. What patients do not want is 4 more weeks of a treatment in which they do not see any benefit. To someone with a non-healing wound, wearing "baby flies" for 2 days is not too high a price to pay, if the potential for success is what is reported with MDT."

To read more about maggot therapy for diabetic ulcers on the Wound Care Information Network website, Click Here.

The Link between TB and diabetes

October 28th, 2013

There is a clear link between diabetes and TB. A person who has diabetes is at a much higher risk - almost 2 to 3 times higher of developing TB or Tuberculosis than others. It has also been noted that almost 10% of all Tuberculosis cases are linked with diabetes.

Double burden of the diseases globally

The increasing number of diabetes patients is a huge challenge in controlling TB. In most low and middle income countries such as regions in Asia and Africa where TB is a huge public health issue diabetic cases are increasing fast.

How to Treat and Screen both the diseases?

Diabetes weakens the immune system and affects the metabolic processes of the fat tissues - thereby making the body succumbs to the attack of infectious disease like TB. Study has shown that a patient with diabetes is more prone to fail treatment of TB and also is more likely to die during a treatment. Someone with diabetes who has a good control over the glucose levels are at a lesser risk to get TB. Also the treatment of TB helps to decrease the blood glucose levels in the body.

Studies to prove this

Megan Murray and Christie Jeon from the Harvard School of Public Health have been working on this subject for a while and have used data from the last 40 years to do 13 different detailed studies with more than 1.7 million people participating and 17698 cases of TB. Their in-depth study summarized that Diabetes mellitus greatly increases the risk of developing active tuberculosis.

Recently at the Broad Institute of MIT and Harvard in Cambridge there was a researcher’s symposium that aimed at sharing thoughts and studies to unravel the linkage. Many eminent speakers (like Melvin J., Sarah Fortune and L. Glimcher) from the Harvard School of Public Health opened by saying that the number one risk of developing Tuberculosis isn’t HIV but diabetes. The aim of this meet was to discuss the development of new age drugs and treatments to cure and control such diseases.

An effort to address this issue

A four year innovation and research project called the TANDEM with the aim to answer a lot of questions between the relationship of these two disease has been launched a few months back (April 2013). It is run by the London School of Hygiene and Tropical Medicine. The idea is to get different disciplinary partners and sites together in Romania, Indonesia, Peru and South Africa with labs in Netherlands, Romania, UK, South Africa and Germany. This project has been setup to find the best way to diagnose TB in diabetic patients and vice versa and also to analyse why some people with both the disease do not respond to treatments and whether genes are related to the linkage between these diseases.

How to manage both the diseases?

In countries like Egypt, Mexico, USA and Saudi Arabia where the number of diabetic cases is higher, diabetes is seen to be a significant contributor to TB case numbers.

Since it is clear that there is link, it becomes very important to manage the diseases effectively, by aiming to detect them in early stages so as to avoid serious complications, offering well guided public treatments and a good drug supply to cure them. These steps will aid in effective detection and treatment of diabetes as was done to globally control TB.