New drugs for diabetic foot ulcer are urgently needed in China
Last Update: 2020-06-19
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The population of diabetic foot ulcer (DFU) in China is close to 10 million, which has a high rate of disability and death, and a serious social and economic burdenHowever, limited by the hardware resources such as medical staff and beds, and the poor effect of current treatment methods, the vast majority of patients can not be fully and effectively treatedIt is hoped that there will be new products with high healing rate, fast healing speed, low recurrence rate, cost-effective and convenient application< br / > diabetic foot ulcer (DFU) is one of the main causes of disability and death in diabetic patientsDue to the lack of sufficient medical resources and effective drugs, the prognosis of the disease is poor, and the clinical mortality and disability rate are even higher than most cancersMore than 85% of diabetic amputations are caused by DFU, which brings serious treatment and economic burden to patients and societyAs one of the most urgent unmet needs in the field of diabetes, this disease should be paid more attention< br / > China's DFU patients have a large scale, with a high rate of death and disability: in the past 30 years, the prevalence of diabetes in China has soared from an average of 0.67% to 11.6%, among which the prevalence of diabetic foot ulcer is about 5.5% , thus, the number of diabetic foot ulcer patients in China is close to 10 millionThe annual mortality rate of DFU patients is as high as 11%, and amputation patients is as high as 22% < br / > China's DFU has caused a serious economic and social burden: in 2017, the global medical expenses for diabetes reached 727 billion US dollars, and China accounted for 110 billion US dollarsAbout 30% - 40% of them are diabetic foot treatment expenditure , more than 30 billion US dollarsAccording to the multi center survey in 2004, the average daily hospitalization cost of DFU patients was 14906 yuan; in 2012, the average daily hospitalization cost of DFU patients almost doubled compared with 2004 (955 yuan vs 589 yuan)According to the survey of multi center amputation rate of diabetes in 2010, patients with a disease course of more than 20 years had the longest hospitalization days (42 days) and the most hospitalization expenses (34253 yuan)< br / > for patients and for patients: more than 85% of diabetic amputations are caused by DFU, which results in life disability due to no effective or delayed treatment< br / > for the family: at the same time, DFU patients are sick, the whole family takes care of them, the huge medical expenses and labor income are suddenly reduced, which causes heavy burden on the family< br / > for medical staff: doctors need to conduct DFU diagnosis and treatment for a long time, and at the same time consult multi-disciplinary (MDT) joint diagnosis and treatment, the healing process is variable, causing continuous burden on doctors and hospitals< br / > China's DFU is short of beds and patients' treatment time is seriously insufficient: according to the latest health statistics bulletin , the utilization rate of hospital beds in China is 83.6%, and the average hospital stay of discharged patients is 9.1 days The length of stay of DFU patients is about 18 days  However, the average healing time of diabetic foot ulcer wound is about 113 days, and the median healing time is 75.5 days  < br / > < br / > the healing time of diabetic foot ulcer is far longer than the actual hospitalization time On the one hand, the patients need to face the fact that the wound does not reach the healing standard when they are discharged from hospital, and even the wound still needs to be debridement outside the hospital when they are discharged from hospital, at the same time, they also need to face the recurrence rate of ulcer healing over 31% , On the other hand, the long-term hospitalization time and the high recurrence rate of ulcer lead to the increase of medical staff's diagnosis and treatment time, the increase of bed demand and medical expenditure < br / > at present, there is a lack of effective drugs, and the treatment effect of patients is not good: at present, for diabetic foot ulcer, firstly, through wound debridement to remove carrion and necrotic tissue and control infection, then carry out comprehensive treatment of internal surgery to accelerate wound healing and repair the wound Physical debridement is the basis of wound treatment When physical debridement is not suitable, other kinds of debridement, such as autolysis debridement, enzymology debridement, traditional dressing debridement and maggot debridement, can be selected < br / > however, the healing rate of these debridements is relatively limited, which still needs about half a year At the same time, the new treatment plan, represented by biological agents, needs to stay for a while while while receiving treatment in the hospital, which does not significantly shorten the length of stay in hospital < br / > there is an urgent need for new drugs that are more effective, can significantly shorten the treatment cycle, and are easy to use in clinic < br / > although there are many methods to treat diabetic foot at present, due to the complex mechanism of diabetic foot, the existing treatment methods can not make patients get full treatment, let alone completely solve this clinical problem In the future, new drugs and treatment methods need to be explored constantly, In particular, there are new products with high healing rate, fast healing speed, low recurrence rate, cost-effective and convenient application So as to further improve the survival rate and quality of life of diabetic patients, and benefit the society < br / > References: < br / >  Zhang P, Lu J, Jing y, et al Global diabetes of diabetic foot: a systematic review and meta-analysis [J] Annals of medicine, 2016, 49 (2): 1-21 < br / >  Diabetes Society of Chinese Medical Association Chinese guidelines for prevention and treatment of diabetic foot (2019 Edition) [J] Chinese Journal of diabetes 2019, 11 (2): 92-108 < br / >  statistical bulletin on the development of China's health service in 2019, < br / >  ban Yijuan, ran Xingwu, Yang Chuan, et al Comparison of clinical data and hospitalization expenses of diabetic foot disease in some provinces and cities of China [J] Chinese Journal of diabetes, 2014,6 (7): 499 ⁃ 503 < br / >  Smith str ø m h, Iversen mm, igland J, Et al Severity and duration of diabetic foot Soccer (DFU) before seeking care as predictors of healing time: a retrospective cohort study Plosone 2017; 12 (5): e0177176 Published 2017 May 12 < br / >  Wang Chun, ran Xingwu Where is the way to manage diabetic foot in China? [J] Chinese Journal of diabetes, 2018,10 (7): 441-444
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