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Diabetic Foot Outpatient Clinic for diabetic patients requiring foot care

Healthcare Programs Promoted at the University of Tokyo Hospital
Programs Currently Underway in Clinical Settings
Department of Diabetes and Metabolic Diseases, Nursing Department

According to an estimation based on the results of the 2012 National Health and Nutrition Examination Survey conducted by the Ministry of Health, Labor and Welfare, approximately 9.5 million people are strongly suspected of having diabetes in Japan. At our hospital, diabetes specialists provide high-quality medical care to diabetic patients in collaboration with certified Japanese diabetes educators. As a specialized outpatient care center for diabetes, the activities of the Diabetic Foot Outpatient Clinic are described in this section.

1. Diabetes and blood glucose

The carbohydrates obtained from dietary sources are digested by the living body and are converted into glucose, which is delivered to the cells all around the body through the bloodstream. Humans’ indispensable energy is produced in the cells. The blood glucose concentration (blood glucose level) is adjusted by insulin, a hormone produced in the pancreas. Due to a reduction in insulin or a decline in the insulin function, diabetic patients cannot take in glucose effectively. Meanwhile, increased blood glucose concentrations cause hyperglycemia.
In addition to the blood glucose level, the HbA1c level in the blood also reflects the blood glucose status. Hemoglobin, a protein contained in the red blood cells, transports oxygen to every cell in the body. Glycated hemoglobin is produced by the binding of glucose to hemoglobin, and the glycated hemoglobin is then measured in the form of HbA1c. In cases in which a hyperglycemic condition persists, excess glucose accumulates in the blood. HbA1c accumulates as the red blood cells travel around the body. The blood glucose level is suitable to understand the status at the time of the examination, whereas HbA1c can be used effectively to estimate the status in the past one to two months.

2. Diabetes and foot and leg lesions

A continuous hyperglycemic state imposes stress on the vessels. As thin and fragile vessels are vulnerable to damages, three major diabetes complications can develop in areas containing many capillaries: diabetic neuropathy, diabetic retinopathy, and diabetic nephropathy. Among these, diabetic neuropathy is likely to develop first. The latter causes an uncomfortable sensation or numbness in the tips of the fingers and toes, and an aggravation of these symptoms may lead to the amputation of a finger or a leg. Diabetic neuropathy impairs the nerves contained in the fingertips, making patients less sensitive to increased temperatures and to pain, and less aware of injuries and abnormalities. As diabetes compromises the body’s immunity, diabetic patients are vulnerable to infection. Even minor injuries, including a blister on the foot, cutting a nail too short, and athlete’s foot, are serious pathological conditions in diabetic patients.
Foot and leg lesions progress in a stepwise manner. The initial symptom is a defect of the thin skin surface called erosion. Erosion then makes its way into the skin and reaches the subcutaneous fat. The defect of the subcutaneous fat results in ulceration. The ulcer then makes its way into the muscle, joint, and bone – a condition called necrosis. Lesions other than skin lesions appear. For example, muscle weakness causes atrophy of the muscles, and the toes are maintained in a crooked state and deformed. These foot and leg lesions gradually worsen. Therefore, diabetic patients should check their feet and legs frequently and should keep them clean to prevent foot and leg lesions. The early detection and early treatment of foot and leg lesions is also important. At the Diabetic Foot Outpatient Clinic, healthcare professionals provide care tailored to diabetic patients with early-stage foot and leg lesions.

3. Diabetic Foot Outpatient Clinic

At the Department of Diabetes and Metabolic Diseases of the University of Tokyo Hospital, diabetes specialists provide high-quality medical care to diabetic patients in collaboration with certified diabetes educators of Japan (CDEJs*). An average of around 180 patients come to the outpatient clinic to receive treatment every day. Every Thursday, patients come to the Diabetic Foot Outpatient Clinic to receive early care for diabetic foot and leg lesions. The uniqueness of this outpatient clinic is reflected in its team approach. A team composed of certified diabetes nurses (nursing specialists providing foot care from the comprehensive viewpoint of diabetes), certified skin/toilet support nurses (nursing specialists providing comprehensive diabetes care focused on diabetic foot care), and research nurses/engineering specialists engaged in scientific research at the graduate school (specialists who can conduct objective/technological assessments) offer preventive care for diabetic foot and leg lesions.
At the Diabetic Foot Outpatient Clinic, a patient undergoes examinations and care for 60-80 minutes. (See the figure below.) All the patients who have undergone treatment at this outpatient clinic are eligible to receive various forms of support. For example, they can undergo regular care whenever necessary. Depending on their condition, they are advised to go to different departments to receive specialized treatment. For patients who need to order shoes, the necessary foot information is provided.
This section cast light onto the Diabetic Foot Outpatient Clinic. Diabetes is a disease that gradually damages the vessels all around the body. The condition is likely to cause various complications besides foot and leg lesions, including cerebral infarction and myocardial infarction. However, appropriate treatment and care can help to reduce the risks of developing these complications. Diabetes treatment is evolving every day. At this hospital, we conduct medical treatment and research, and hold an outpatient diabetes seminar – usually once a week – for patients and the general public. By making the most of this opportunity, you can learn more about diabetes and find an optimal way to live with the disease.

*Certified diabetes educators of Japan (CDEJs): nurses, registered dietitians, pharmacists, clinical technologists, and physical therapists with specialized knowledge of diabetes and the methods to teach diabetes care, who have been qualified as professionals capable to provide experienced guidance for diabetic patients under the supervision of physicians.

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