New opportunities for DFU patients: Blood sugar control, diet, and exercise

Prevention- Healthy lifestyle
(Healthy Lifestyle)

In the long term, maintaining a healthy lifestyle is beneficial for both diabetes prevention and the prevention of diabetic foot ulcers (DFU). Improving patients' lifestyles, medical adherence, and appropriate treatment strategies will help to enhance their quality of life1.

The Importance of Blood Sugar Control

Blood sugar control is a very important aspect for patients with diabetes. Although there is no solid evidence that blood sugar control is significantly related to wound healing, there is a positive correlation between them, and blood sugar control has been proven to reduce the risk of lower limb amputation. Therefore, it is still recommended that DFU patients maintain good blood sugar control to reduce inflammation and infection risks, and to improve wound healing outcomes2.

Diet to Ensure Adequate Nutrition

Many patients with DFU suffer from some degree of malnutrition. Although there are no well-supported nutritional intervention studies, dietary control of blood sugar and ensuring sufficient intake of vitamin D and proteins may be helpful for the patients3.

Exercise with Foot Protection

Regarding exercise for DFU patients, the International Working Group on the Diabetic Foot (IWGDF guidelines) state: "As long as appropriate footwear can be worn, the risk of foot ulcers is not an impediment to exercise.4"

Although exercise may not significantly improve wound healing, it can reduce parts of the wound area and does not increase the risk of ulcers recurrence2,5. Moreover, studies have shown that the higher the compliance with exercise, the better quality of life, physical and social functions1. Therefore, patients should be encouraged to engage in appropriate exercise following professional advice with proper foot protection.

Establishing Good and Close Relationships to Improve Lifestyle

Improving patients' lifestyles and enhancing the relationship between patients and healthcare providers and caregivers to increase their medical adherence should all be in the treatment strategies1.

DFU is associated with an increased risk of death, fatal myocardial infarction, and stroke. However, studies indicate that a considerable proportion of DFU patients still have habits of smoking or drinking. Additionally, patients often suffer from obesity, dyslipidemia, and hypertension. There is a 25-88% non-adherence rate to diet, exercise intervention, and foot care1.

Polikandrioti M et al. Int J Low Extrem Wounds. 2020;19(2):165-179.
Everett E et al. Ann N Y Acad Sci. 2018;1411(1):153-165.
Armstrong DG et al. JAMA. 2023;330(1):62-75.
Chen P et al. Diabetes Metab Res Rev. 2023;e3644.
Tran MM et al. Foot Ankle Res. 2021;14(1):19.