Endocrine Abstracts

Introduction: Diabetic `neuropathies are a heterogeneous group of disorders with diverse clinical manifestations. Up to 50% of diabetic peripheral neuropathy may be asymptomatic. Glycemic control can effectively prevent diabetic peripheral neuropathy (DPN) in type 1 diabetes (T1D) (1,2) and may modestly slow their progression in type 2 diabetes (3). We report the case of a patient who presented leg burns with no healing making treatment extremely difficult.

Clinical Case: Eighty one years-old patient, diabetic since 34 years treated with insulin, admitted for complicated thermal (contact) burns to the right leg following the use of hot water contained in an unsuitable plastic bottle. Clinically, patient was hemodynamically and respiratorily stable. Examination of the right leg: deep ulceration of the anterior face of the lower third, approx. 10×6×1 cm, with exposed tendons and fibrin deposits with warm red swelling of the homolateral forefoot. Biological tests: capillary glycemia: 5;29 g/l without ketosis, WBC: 11600, CRP: 290 mg/l. A dressing protocol provided by the plastic surgeons was instituted with antibiotic therapy, with no clear improvement and no scarring after 2 months of follow-up. The patient was hospitalized for skin grafting.

Discussion: Symptoms of DPN vary according to the class of sensory fibers involved. The most common early symptoms are induced by the involvement of small fibers and include pain and dysesthesia. The involvement of large fibers may cause numbness and loss of protective sensation (LOPS) and it is a risk factor for diabetic foot ulceration. Near-normal glycemic control, implemented early in the course of diabetes, has been shown to effectively delay or prevent the development of DPN mainly in T1D. Dyslipidemia is a key factor in the development of neuropathy in people with type 2 (4,5). Positive effects of physical activity, weight loss, and bariatric surgery have been reported in individuals with DPN, but use of conventional lipid-lowering pharmacotherapy (such as statins or fenofibrates) does not appear to be effective in treating or preventing DPN development (6). Our patient’s long-standing diabetes and inability to feel the high temperature when using hot water, testify to the absence of the sensation of protection and confirm the advanced damage to the essentially large sensory fibers. The absence of healing is evidence of associated vascular damage.

Conclusion: Foot ulcerations and amputations are common complications associated with diabetes especially when there is a triggering mechanism such as burns.

Keywords: DPN, burn, glycemic balance, healing.