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Colegio de Medicina Interna de México.

2009, Número 6

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Med Int Mex 2009; 25 (6)


Guía clínica basada en evidencia para el manejo del pie diabético

Castro G, Liceaga G, Arrioja A, Calleja JM, Espejel A, Flores J, García T, Hernández S, López GE, Martínez JF, Nettel FJ, Romero CR, Rosas J, Wacher NH, Cote L, Guzmán RM, Bladinieres E, Márquez G, Alvarez ER

Idioma: Español
Referencias bibliográficas: 143
Paginas: 481-526
Archivo PDF: 807.16 Kb.


RESUMEN

Antecedentes: las infecciones y úlceras del pie en los pacientes con diabetes son comunes, complejas y de alto costo. Son la principal causa de amputación no traumática de las extremidades inferiores. El tratamiento de esta complicación debe ser multidisciplinario, oportuno y eficaz, con el fin de reducir potencialmente la morbilidad relacionada con las infecciones, la necesidad de estancias hospitalarias prolongadas y las amputaciones. Por desgracia, la mayor parte de las veces la atención de estos pacientes es inadecuada, quizá debido a mal entendimiento de los enfoques diagnóstico y terapéutico; de ahí la necesidad de unificar criterios y la formación de una guía clínica que ayude a disminuir la morbilidad, el agotamiento psicológico y los costos financieros vinculados con las úlceras y las infecciones del pie diabético.
Método: se invitó a participar en la elaboración de la guía a 19 médicos especialistas procedentes de diversas instituciones, especialidades y estados de la República Mexicana. Los invitados se seleccionaron con base en criterios de experiencia en el tema y conocimiento de la metodología para el desarrollo de esta guía. Las recomendaciones se basaron en niveles de evidencia clínica, para que las mismas se apliquen en la población, llegando a conclusiones razonables.
Resultados: se realizaron las discusiones con los expertos en el tema para implantar la logística de la formación de la guía de recomendaciones. Los expertos definieron el alcance de la guía, los temas a evaluar y las preguntas relevantes a las que se debía dar respuesta.
Conclusiones: el tratamiento del pie diabético debe enfocarse, principalmente, a los mecanismos patogénicos desencadenantes y a la atención multidisciplinaria con pronóstico favorable. El esquema general de la terapéutica del pie diabético consiste en: control del estado metabólico y luego del tratamiento específico, dependiendo del grado de afectación clínica. Como medidas generales y de tratamiento preventivo debe enseñarse a los pacientes cómo cuidar los pies e inspeccionarlos continuamente. En relación con el control de los valores de glucosa sanguínea, se demuestra que existe una correlación estrecha entre la hiperglucemia y la aparición y gravedad de la neuropatía diabética acompañante del pie diabético, que forma parte de los factores de riesgo para úlceras en el pie.


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