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  #1  
Old 10-30-2012
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Question Most effective measure to prevent diabetic foot infections

A 50-year-old man with a 20-year history of type 2 diabetes mellitus has had sensory neuropathy for 2 weeks. Pulses are decreased at the ankle. There is no peripheral edema. His serum glucose levels have been between 150 mg/dL and 200 mg/dL over the past 6 months. Which of the following is the most effective measure to prevent serious foot infections?
A) Use of support hose
B) Use of well-fitted shoes
C) Prophylactic antibiotics
D) Daily aspirin and dipyridamole
E) Decrease in serum glucose level
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Old 10-30-2012
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E) Decrease in serum glucose level
I think the most effective method of prevention is strict glycemic control to prevent vascular and neurologic complications + patient should receive instructions on daily foot self-examination (to look for abrasions and blisters), wearing appropriate shoes, cutting toenails straight across, and avoiding barefoot walking.
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Old 10-30-2012
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I think this is from NBME 2. I had also marked this as E but I think the answer is B
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Old 10-30-2012
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It is E, unless the question writer is stupid.

The question asks for the MOST effective way to prevent ulcers, that MOST effective way is to have a good sugar control to stop the ongoing hypoxia and **** that is going on.

the other measures are cute and effective but without them and a good glycemic control you would still achieve a rather good prevention.
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its B as he already has neuropathy, so to prevent ulcer .
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Old 10-30-2012
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I think what the question writer is trying to convey is that the sensory neuropathy is not going to be reversed by a good glycemic control but the immediate concern is to prevent the development of neuropathic ulcer and it's associated complications (infection--> osteomyelitis). Therefore, the foot care is the most immediate concern to prevent foot infection. Glycemic control will be useful in the long term to prevent further damage to the peripheral nerves but will not be of much help in preventing the development of the foot ulcer.
If the patient already had an infected diabetic ulcer then the glycemic control be the right answer since it will help to control the infection and promote healing.
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Old 08-04-2013
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Are you sure the correct answer was B, according to the NBME profesors?

novobicin: Ok, there is neuropathy, but high glc interferes with immunologic processes (microvascular damage, decreased phagocytosis), so keeping glc normal would decrease serious infections.

Was searching some official recommendations, found only RF for amputations (which correlate with serious foot infections):
Quote:
The risk of ulcers or amputations is increased in people who have the following risk factors:
  • Previous amputation
  • Past foot ulcer history
  • Peripheral neuropathy
  • Foot deformity
  • Peripheral vascular disease
  • Visual impairment
  • Diabetic nephropathy (especially patients on dialysis)
  • Poor glycemic control
  • Cigarette smoking
I feel like E is correct in a patient with glc between 150 and 200.
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Old 08-04-2013
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Default NBME question

Its NBME 2 question btw, this must be mentioned when posting this.
Its a spoiler.

Anyway I believe its B.
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