Plantar ulcers, a serious complication of diabetes, significantly impact patients' ambulation, clinical status, and quality of life. Therapeutic footwear helps prevent ulcers, but tighter fit is needed. Neuropathic patients also exhibit unstable gait and a high risk of falling. Elevated concentrations of advanced glycation end products (AGEs) in bone are related to diabetic complications and may help detect early progression of neuropathy. Vitamin D deficiency appears to be associated with muscle weakness, imbalance, and neuropathic pain, but further investigation is needed.
The aim is to promote an innovative multidimensional approach to gait problems in very elderly patients with diabetes, leveraging advanced orthopedic technology (applied research) and novel metabolic biomarkers (translational research). Twenty diabetic neuropathic patients were enrolled. Instrumental assessment of motor function and advanced 20D techniques complement the current prescription of foot orthoses. Vitamin D supplementation was administered to support the function of the musculoskeletal system. Detection of fluorescent advanced glycation end products (fAGEs) will be validated and data will be correlated with neuropathy progression. Results such as reduction of falls and plantar ulcers; increased adherence to treatment; improvement of key clinical and biomechanical parameters were obtained. It is also expected that the feasibility of introducing novel biomarkers into the clinical care model for early detection of neuropathy progression will be demonstrated.
This research was funded by the Italian Istituto Superiore di Sanità (ISS), under grant number ISS2020-DIAPASON.
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