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Diabetes mellitus is a chronic condition marked by elevated blood glucose levels due to abnormal insulin production or insulin resistance, leading to complications of the heart, kidneys, eyes, blood vessels and nerves. Type 2 diabetes specifically is associated with skin issues like chronic foot ulcers and increased infections, potentially due to disruptions in the skin microbiome.
What We Know:
In 2021, the global prevalence of diabetes among adults was estimated at 537 million and is projected to rise to 783 million by 2045 (International Diabetes Federation, 2021).
Diabetic foot ulcers (DFUs) are defined as “Ulcers in the foot of individuals with diabetes, often accompanied by lower limb neuropathy and/or peripheral arterial disease.” DFU can also be defined as a chronic skin disease linked to altered bacterial diversity and instability in wound microbiota (Zhang et al., 2023).
The total lifetime risk of DFU complications for patients with diabetes (type 1 or 2) is 25%. These wounds are slow to heal, difficult to treat and vulnerable to infection (Gardiner et al., 2017; Packer, Ali & Manna, 2024).
Bacterial infection is the most common cause of delayed healing in DFUs and the lack of appropriate diagnostic tools makes it difficult to determine if the bacteria in the DFU are due to changes in the original colonised bacteria or an external infection. Few studies have investigated the transition of bacterial flora from healthy skin to diabetic skin to DFU skin (Zhang et al., 2023).
Industry Impact and Potential:
While some bacterial species can hinder wound healing and lead to chronic wounds, others can accelerate healing and prevent pathogen colonisation. Significant differences in skin microbial composition exist between diabetic and non-diabetic patients, with diabetic wounds showing increased levels of Staphylococcus, Aerococcus, Porphyromonadaceae and Proteobacteria, and decreased levels of Streptococcus, Lachnospiraceae and Acinetobacter (Zhang et al., 2023).
There are changes in the bacterial colony structure of DFU skin compared to healthy or diabetic skin without ulcers. In DFU skin, Staphylococcus, Enhydrobacter and Corynebacterium_1 are significantly reduced, while Escherichia coli and Pseudomonas are increased (Zhang et al., 2023).
Thus, the difference between healthy skin and diabetic skin with or without ulcers lies in the balance between normal and pathogenic microbiota. Subsequently, altering the microbiota composition of wounds may help the treatment of DFU (Zhang et al., 2023).
Our Solution:
Sequential offers customisable end-to-end Microbiome Testing for your research needs, like investigating the influence of the skin microbiome on diabetic skin and wound healing. Sequential offers real-world testing scenarios, and additionally formulation support to develop products that maintain microbiome stability for the skin, as well as for the oral, scalp and vaginal microbiomes.
References:
Gardiner, M., Vicaretti, M., Sparks, J., Bansal, S., Bush, S., Liu, M., Darling, A., Harry, E. & Burke, C.M. (2017) A longitudinal study of the diabetic skin and wound microbiome. PeerJ. 5, e3543. doi:10.7717/peerj.3543.
International Diabetes Federation (2021) IDF Diabetes Atlas. 2021. IDF Diabetes Atlas. https://diabetesatlas.org/ [Accessed: 5 July 2024].
Packer, C.F., Ali, S.A. & Manna, B. (2024) Diabetic Ulcer. In: StatPearls. Treasure Island (FL), StatPearls Publishing. p. http://www.ncbi.nlm.nih.gov/books/NBK499887/.
Zhang, X.-N., Wu, C.-Y., Wu, Z.-W., Xu, L.-X., Jiang, F.-T. & Chen, H.-W. (2023) Association Between the Diabetic Foot Ulcer and the Bacterial Colony of the Skin Based on 16S rRNA Gene Sequencing: An Observational Study. Clinical, Cosmetic and Investigational Dermatology. 16, 2801–2812. doi:10.2147/CCID.S425922.
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