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Introduction
Prevalence
• Diabetic foot ulcers (DFU) are chronic wounds in the foot or feet
associated with neuropathy and/or peripheral artery disease (PAD) of the
lower limb in patients with diabetes mellitus.
• Reports from the Centers for Disease Control and Prevention show that in
the United States there are nearly one in four adults living with diabetes,
which indicates that a large number of Americans are at risk of DFU.
• DFUs will develop in up to 34% of patients with diabetes at some time
in in their lives, and of those, approximately 15%–25% will require an
amputation.
• Moderate or severe malnutrition has been identified in over half of patients
with DFU, and malnutrition in DFU is correlated with increased lower-
extremity amputation.
• Improvements in wound care therapy, including nutrition interventions,
can reduce the financial burden of DFUs and increase life expectancy and
quality of life.
Challenges and Goals
• There is no internationally agreed upon standardized definition of
malnutrition, neither for protein energy malnutrition nor for micronutrient
deficiency, in the context of chronic wounds or in DFU.
• There is a lack of high-quality randomized controlled trials to evaluate the
benefits of nutritional supplementation in DFU, and existing studies use a
wide range of outcome variables.
• Ensuring patient compliance when it comes to nutrition can be notoriously
challenging.
• However, there is a clear correlation between nutritional status and healing,
and as such, a balanced diet with adequate fluids, calories, proteins, and
nutrients is fundamental to the healing process.
• The following guidelines are designed to assist the clinician to accomplish
the difficult goal of improved outpatient nutrition to support the healing
DFU wound.
• We recommend that you use your clinical judgement as every patient case
is unique. The nutrition plan should be individualized based on disease state
and/or risk of malnutrition.
