How Diabetic Foot Ulcers Present a Health Risk that Compounding Pharmacists Can Help Prevent
Cuts and scrapes are such a normal part of life that we often take the healing process for granted, until something goes wrong—and diabetic patients are at a high risk for things going wrong. Samantha learned about foot care when she was diagnosed with type 2 diabetes, but months passed, she felt fine, and she didn’t give foot care much thought. As a result, she didn’t pay attention to the blister that appeared on her foot after a night of dancing and before long, it was a full-blown ulcer. Samantha spent months in treatment and faced a close call with amputation. As a compounding pharmacist, you can offer counseling to patients in an effort to help prevent diabetic foot ulcers and create topical treatments to facilitate healing when one does occur.
Research Sheds New Light on Diabetic Wound Healing
Foot ulcers are the most common and costly complication of diabetes.1 They affect about 15 percent of diabetic patients and represent one of the top three causes of all non-healing wounds treated at outpatient wound centers in the United States.2 Most cases stem from peripheral neuropathy, as the resulting loss of sensation leads to injuries and deformities that go untreated. While early treatment of diabetic foot ulcers significantly lowers the risk of complications and amputations, the prognosis is still discouraging. Even when treatment is successful and the ulcer heals, the recurrence rate is 66 percent and the amputation rate rises to 12 percent.3
Considering the poor prognosis, it’s encouraging to know that researchers have made progress and can better define the underlying mechanisms responsible for defective wound repair in diabetics. The first break came in October 2013 when a team found that forkhead box O1, or FOXO1, enhanced wound healing by protecting keratinocytes from oxidative stress.4 More recently, experts discovered that it has the opposite effect in diabetics. When glucose is too high, FOXO1 fails to up-regulate the appropriate signaling pathway, so it inhibits keratinocyte migration and impairs re-epithelialization.5 In addition to being a potential therapeutic target for diabetic foot ulcers, emerging evidence implicates FOXO1 in other diabetic complications such as diabetic retinopathy and cardiomyopathy.
Compounded Topical Treatments for Diabetic Foot Ulcers
When a minor foot injury develops into an ulcer, time is critical and treatment must move quickly. Blood glucose is stabilized and a therapeutic plan is created that includes the appropriate combination of off-loading, debridement, oral antibiotics if infection is present, and dressings that ensure a moist environment. A non-responsive wound may benefit from advanced treatments such as Apligraf, Dermagraft, and Regranex Gel, or the physician may consider other adjunctive therapies. Common comorbidities such as hypertension, atherosclerosis, and hyperlipidemia must also be managed.
Compounded topical treatments are beneficial for grade I and II diabetic foot ulcers, which often need multiple medications to stimulate tissue growth, improve vascular perfusion, achieve debridement, reduce pain, and fight infection.6 Treatment is simplified and patient compliance is enhanced when several pharmaceuticals are combined into one compounded application. While a variety of medications are available, some of those commonly prescribed include:
- Phenytoin to promote granulation tissue formation
- Misoprostol to accelerate wound healing
- Metronidazole, itraconazole, and other antimicrobials
- Topical collagenase or other enzymes compounded at greater strength for debridement
- Nifedipine and verapamil to enhance vascular perfusion
- Lidocaine for pain relief
- Diclofenac or flurbiprofen to fight inflammation
Podiatrists and family physicians are often on the front line of diabetic foot care, so it’s worth your time to connect with practitioners in your area. If they’re not already using compounded pharmaceuticals, talk with them about the advantages of working with you to develop the best treatments for their patients.
Create a Diabetes Education and Supply Hub
About half of patients with diabetes don’t adhere to their treatment plan, which creates a serious problem and potentially deadly consequences. Sixty percent of your patients will stop taking their glucose-lowering meds within two years, thus increasing the risk of neuropathy and foot ulcers. Diabetes is the seventh most common cause of death in the United States. When compounding pharmacists intervene, adherence and self-care increases, which in turn promotes long-term health. Establish your pharmacy as the place to go for diabetic health care:
Medication Synchronization: Connect with diabetic patients who already fill prescriptions at your pharmacy. Establish a medication synchronization program and schedule appointments. After you review meds, talk about medication side effects and ask if they’re following a daily foot-care routine.
Ask-the-Pharmacist: Put up posters about diabetes, diabetic self-care, and potential new treatments. For example, a hemoglobin spray to treat slow-healing wounds such as foot ulcers has been approved in the European Union and is expected to enter the US market. A poster announcing the potential to be the first to use an innovative foot spray—with an invitation to “ask the pharmacist”—will open the door to communication.
Diabetes Education: Dedicate an area as your diabetes education center. Put an informative poster highlighting the critical role of daily foot care in a prominent spot. Don’t hesitate to include a few statistics for shock value and to make patients aware of the health risks. Have pamphlets with basic foot care guidelines, as well as referrals to diabetic specialists and podiatrists.
Stock Diabetic Supplies: While patient care is your guiding motivation, you also run a business and people with diabetes are likely to visit your pharmacy more often than those who don’t have the disease.7 Make sure you have basic supplies in stock and consider where they’re located in the store. If diabetic foot creams and intensive skin care items are shelved with all the other skin care products, move a few to the diabetic section.
Protect Patients’ Health While Tapping the Market
Of all the statistics surrounding diabetes, one of the most eye-opening is this: One in four people don’t know they have diabetes.8 That number represents an estimated 8 million people—a group that may already be affected by neuropathy and at risk of diabetic foot ulcers, even if they’re unaware of the danger. With only a little effort, some patient outreach, and store planning, you can grow your business and protect your patient’s health and longevity.
Pharmaceutica North America provides quality pharmaceuticals to support your compounding needs, including bulk APIs and an emollient delivery base suitable for diabetic foot ulcers. Contact us today to talk about how we can support your diabetic outreach and treatment.
- “Literature Review on the Management of Diabetic Foot Ulcer,” February 2015, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4317316/ ↩
- “Wound Care Outcomes and Associated Cost Among Patients Treated in US Outpatient Wound Center: Data From the US Wound Registry,” January 2012, http://www.woundsresearch.com/article/wound-care-outcomes-and-associated-cost-among-patients-treated-us-outpatient-wound-centers-d ↩
- “Diabetic Ulcers,” September 2015, http://emedicine.medscape.com/article/460282-overview#a6 ↩
- “FOXO1 Promotes Wound Healing Through the Up-Regulation of TGF-Beta1 and Prevention of Oxidative Stress,” October 2013, http://jcb.rupress.org/content/203/2/327 ↩
- “FOXO1 Differentially Regulates Both Normal and Diabetic Wound Healing,” April 2015, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411275/ ↩
- “Utilizing Topical Compounded Medications to Modulate Wound Healing,” August 2014, http://www.podiatrytoday.com/utilizing-topical-compounded-medications-modulate-wound-healing ↩
- “Diabetic Sales: Tips for Offering Supplementary Diabetes Products,” September 2015, https://www.pbahealth.com/diabetic-sales-tips-for-offering-supplementary-diabetes-products/ ↩
- “National Diabetes Statistics Report, 2014,” June 2014, http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf ↩