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Intervention
Enteral and Parenteral Nutrition
• If a patient is unable to meet estimated nutrient, energy, protein, and
hydration needs despite nutrition interventions:
▶ Discuss with patient the benefits and harms of enteral or parenteral feeding to
provide additional or an alternative source of nutrition support.
Special Populations
• Overweight and Obese Patients
▶ Most diabetic patients are overweight or obese, which by definition, is
malnutrition.
▶ Many such patients are sarcopenic, with decreased lean body mass despite excess
body weight.
▶ It is possible for the overweight or obese patient to meet the metabolic needs of
the healing wound while simultaneously losing weight.
▶ Weight loss improves diabetes control which helps heal the wound but also
decreases the pressure on the DFU in the ambulatory patient.
• Older Adults
▶ A significant number of patients with diabetes are geriatric.
▶ Geriatric patients also have a variety of social and physiologic issues that lead to
decreased protein and micronutrient intake.
▶ Many geriatric patients should be considered malnourished until proven
otherwise.
