April 2019 Dallas Medical Journal 7
comprehensive wound center, a
certified wound specialist physician
or podiatrist who is trained in wound
care. Comprehensive wound centers,
through the use of standardized
evidence-based clinical practice
guidelines, are viable resources
because patients have access to
proven interventions not commonly
found elsewhere. They will have
treatment plans that may include
surgical debridements, application
of negative pressure wound therapy,
placement of advanced cellular and/
or tissue-based products, hyperbaric
oxygen therapy and total contact
casting which is the gold standard for
off-loading DFUs while keeping the
patient ambulatory.
CONCLUSION
Diabetic foot ulcers are a challenge
with severe consequences if not
treated correctly and are more
prevalent in minority populations.
When DFUs are identified, early
intervention is key to improving
successful healing. Patients with
diabetic neuropathy or severe
peripheral arterial disease, who
are at great risk for developing
ulcers, should be identified and
educated regarding reduction of
risk factors such as keeping good
glycemic control, and performing
regular foot inspections for
changes in temperature, swelling,
calluses, breaks in the skin or other
abnormalities. Other risk factors
under their control should also
be addressed, such as smoking
cessation, wearing proper fitting
socks and shoes and proper nutrition
through wholesome food intake
and adequate hydration with water
intake. Once an ulcer has formed,
timely referral to a specialist trained
in the care of diabetic foot ulcers is
imperative for increased success.
Sometimes immediate referral to the
hospital emergency department is
necessary for admission to control an
infection related to the diabetic ulcer.
Also effective communication with
the attending hospitalist and inpatient
care coordinators for timely referral to
either an outpatient comprehensive
wound center upon discharge home,
or to a facility with a qualified wound
specialist if the patient is unable
to return home, is necessary for
continued high-quality care. DMJ
References
1. National Diabetes Statistics
Report, 2017 www.CDC.gov
2. www.CDC.gov/diabetes
3. Reiber GE, Vileikyte L, Boyko EJ,,
et al. Causal pathways for incident
lower-extremity ulcers in patients
with diabetes from two settings.
Diabetes Care. 1999 Jan; 22(1):157-
62.
4. www.doihaveprediabetes.org
Maxine Theriot, MD, is a Certified
Wound Specialist Physician and
Certified Medical Examiner of
Divers. She is board certified in both
Family Medicine and Undersea and
Hyperbaric Medicine. Currently, Dr.
Theriot is the Medical Director of
Baylor Scott & White Comprehensive
Wound Center at Las Colinas – an
affiliate of BSWMC- Irving and the
Baylor Scott & White Comprehensive
Wound Center at Waxahachie. Dr.
Theriot is a proponent of a whole
food plant-based dietary lifestyle.
And she facilitates a faith-based
health and wellness seminar entitled
C.R.E.A.T.I.O.N Health.
MINORITY HEALTHCARE SPECIAL FEATURE