Type 2 Diabetes, Foot Ulcers and Cognition

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Summary:  Research group finds that type 2 diabetics with foot ulcers possess fewer cognitive resources than a matched group of type 2 diabetics without foot ulcers.

The harmful impact of diabetes on peripheral and central nervous system functioning is well documented. Peripherally, approximately 50% of people suffering from diabetes will, over the course of the disease, develop diabetic polyneuropathy, the most common form of diabetic peripheral neuropathy.  The harmful impact of diabetes on the central nervous system is also well established. Diabetes is a risk factor for cognitive decline.  In fact, some researchers classify Alzheimer’s Disease as Type 3 diabetes.

There is a well-established correlation between the increased severity of polyneuropathy—with the accompanying loss of protective sensation—and diabetic foot ulcers. Now an Israeli research group has found a correlation between diabetic foot ulcers and decreased cognitive ability.  Their work, “Cognitive Dysfunction: Part and Parcel of the Diabetic Foot”, was published in 2016 in the journal Diabetes Careand concluded that type 2 diabetics with foot ulcers possess fewer cognitive resources than a matched group of type 2 diabetics without foot ulcers.

Does this newly discovered relationship—between decreased cognitive ability and foot ulcers in type 2 diabetics—reflect a greater level of generalized neurological dysfunction—both peripheral and central—in these patients? Or are these patients, alternatively, unable to appreciate the long-term consequences of foot ulcers—and thus engage in activities that put their feet at heightened risk because they are unable to recognize the importance of adequately protecting their feet?

In any case, these patients may struggle to complete tasks that require greater cognitive resources, such as following complicated instructions or performing self-treatment regimens. As a result, clinicians may want to account for these possible struggles when caring for type 2 diabetics with foot ulcers.

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