Peptic ulcer development is one of the most frequent complications of type 2 diabetes mellitus (T2DM) due to the increased likelihood of Helicobacter pylori (H. pylori) infection in T2DM patients, resulting in symptoms such as bleeding and perforation

1. Diabetic leg ulcer
-Amit Kumar

2. What is a diabetic leg ulcer?
Diabetic foot ulcer is a skin sore with full thickness skin loss on the foot due
to neuropathic and/or vascular complications in patients with type 1 or type 2 diabetes mellitus.

4. Diabetic foot ulcer has an annual incidence of 2–6% and affects up to 34% of diabetic patients during their lifetime.
Risk factors for developing a diabetic foot ulcer include:
•Type 2 diabetes being more common than type 1
•A duration of diabetes of at least 10 years
•Poor diabetic control and high haemoglobin A1c
•Being male
•A past history of diabetic foot ulcer.
Who gets diabetic leg ulcer?

5. Diabetic foot ulcers are caused by neuropathic and/or vascular complications of diabetes mellitus.
Neuropathic ulcer
High blood sugar levels can damage the sensory nerves resulting in a peripheral neuropathy, with altered or complete loss of
sensation and an inability to feel pain. Peripheral neuropathy develops in approximately 50% of adults with diabetes, increasing
the risk of injury to the feet from pressure, cuts, or bruises.
What causes diabetic leg ulcer?

6. Vascular ulcer
Blood vessels can also be damaged by long-standing high blood sugar levels, decreasing blood flow to the feet (ischaemia) and/or skin
(microangiopathy). This can result in poor wound healing

7. What are the clinical features of diabetic leg ulcer?
A diabetic foot ulcer is a skin sore with full thickness skin loss often preceded by a haemorrhagic subepidermal blister. The ulcer typically
develops within a callosity on a pressure site, with a circular punched out appearance. It is often painless, leading to a delay in presentation
to a health professional. Tissue around the ulcer may become black, and gangrene may develop. Pedal pulses may be absent and reduced
sensation can be demonstrated.

8. How is diabetic leg ulcer diagnosed?
Diabetic foot ulcer is a clinical diagnosis of a painless foot ulcer in a patient with a long history of poorly controlled diabetes mellitus.
Investigations may include:
•Swabs for secondary infection
•X-rays for bone involvement
•Angiography.

9. What is the treatment for diabetic leg
ulcer?
•Optimise diabetes control to reduce neuropathic and vascular complications
•Smoking cessation
•Regular examination of the at-risk foot, and careful toenail trimming
•Prompt treatment of non-ulcerative conditions such as tinea pedis or cracked heels
•Appropriate footwear — properly fitting soft shoes or made-to-measure insoles
•Exercise and physiotherapy
•Education of patient, family, and healthcare providers
Prevention of diabetic leg ulcer

10. General measures
•Multidisciplinary care — may include endocrinologist, podiatrist, diabetes education nurse, wound care nurse, neurologist, vascular
surgeon, and/or orthopaedic surgeon
•Pressure reduction — appropriate footwear, crutches
•Control of blood sugar levels
•Prevention of secondary infection

11. •Treatment of secondary infection
•Ulcer debridement
•Dressings
•Adjuvant therapies — negative pressure wound therapy, ulcer excision and grafting, topical or hyperbaric oxygen, human growth factors,
and/or amputation
Specific measures

12. Medication
•Penicillins
•Cephalosporins
•Carbapenems
•Fluoroquinolones
•Anti-Infective Agents
•Cyclic Lipopeptides