Management of the Diabetic Foot in People with Diabetes Mellitus Older than 65 Years

Round 1

Reviewer 1 Report

The review paper by Álvaro Astasio-Picado and colleagues could be of interest, but it currently has many flaws and its difficult to read. The citations are not precise and lacks cohesiveness.

Specific comments

1.        The statement “inadequate levels of glucose…” with the abstract is inaccurate. In diabetes, the level of glucose is rathe very high “hyperglycemia”

2.        Can you please define “DFUs”? at first mention?

3.        What kind of evidence is the conclusion being drawn? Is it clinical trials or purely basic research?

4.        Citations (within the introduction) for relevance of the topic, including the prevalence, diabetes mellitus and currently available therapies should be revised and updated. Please cite reliable sources.

5.        Within the last paragraph of the introduction, provide a strong motivation for conducting the current study

6.        Was PRISMA method followed for this review?

7.        Within your methodology, you have to describe what type of studies you were targeting

8.        Results are difficult to comprehend, this section should be better structured based on the main findings from extracted evidence

9.        Provide images to better articulate the significant points being discussed, since this is a review paper

Author Response

Dear reviewer,
We appreciate his input and proceed to proofread the manuscript.
Regarding the specific comments:
1. The statement “inadequate glucose levels…” with the abstract is inaccurate. In diabetes, the glucose level is rather very high “hyperglycemia”: totally modified.
2. Can you define "DFU"? on the first mention?: we have removed all abbreviations from the abstract.
3. What kind of evidence is being drawn for the conclusion? Are they clinical trials or purely basic research?: the conclusion has been revised. It is a purely basic investigation.
4. Citations (within the introduction) should be reviewed and updated for topical relevance, including prevalence, diabetes mellitus, and currently available therapies. Please cite reliable sources: reviewed.
5. Within the last paragraph of the introduction, provide a strong motivation for conducting the current study: revised and modified.
6. Was the PRISMA method followed for this review?: This study is a literature review that follows some of the PRISMA method criteria.
7. Within your methodology, you have to describe what type of studies you were targeting: in this section we inform you that we are looking for studies that provide scientific evidence justified by the level of indexing of the articles in journals according to the latest certainties. Inserted two boxes announcing the studies used correctly evaluated.
8. The results are difficult to understand, this section should be better structured based on the main findings of the evidence extracted: reviewed and modified.
9. Please provide images to better articulate the significant points being discussed, as this is a review document - they are introduced as an appendix.
The language is reviewed by the University's language department.
We hope that it is of your consideration.

Reviewer 2 Report

This article analyses the published results of the treatment of patients with diabetic foot. The authors review current articles on topical treatment of trophic ulcers and the prevention of ulcer development. Diabetic foot development prevention methods chosen are patient information tools about diabetes mellitus and the use of orthopaedic footwear.

Analysis of the articles showed that negative pressure therapy and hyperbaric oxygen therapy are the most promising methods for local treatment of trophic ulcers. 

 

1) Teaching diabetic patients how to prevent the development of diabetic foot remains necessary.

 

2) The authors chose to analyse the treatment outcomes of patients over 65 years of age.

Treatment of this age group is quite complex and requires the most comprehensive approaches.

 

3) The authors did not consider methods of conservative therapy of angiopathy, which is the basis of all diabetic foot treatment. Without restoration of blood flow, any local treatment will be ineffective, especially in this age group. Consequently, articles on endovascular therapies have not been evaluated. Patients in this age group require firstly restoration of blood flow in lower limb vessels and then local treatment.

 

4) Consideration of the results of the analysis of contemporary articles on angiopathy treatment methods would greatly improve this article and make it more useful.

 

5) The article lacks an analysis of the results of using modern adhesive, colloidal dressings in local treatment of wounds. 

Without these data, conclusions about the efficacy of negative pressure and hyperbaric oxygen therapy cannot be unequivocally drawn.

 

Other questions: 

1) Why does the sub-heading "classification" only refer to the two widely used classifications, Wagner and Texas University, where WIFI and PEDIS?

2) What time intervals have been chosen for referenced papers, e.g. 2010 to 2022

3) Which method of patient education is most effective? Conducting schools for patients or one-to-one talks, training videos?

Author Response

Dear reviewer,
We appreciate his input and proceed to proofread the manuscript.
Regarding the specific comments:
1) The authors considered analyzing the results of the treatment of patients over 65 years of age by the highest risk age group.
2) The authors do not consider the use of therapy methods such as angiopathy because we focus on non-invasive treatments. Likewise, we consider this contribution for a future manuscript.
3) The article lacks an analysis of the results of the use of modern adhesive colloidal dressings in the local treatment of wounds: a brief review of the dressings has been incorporated, taking into account that there are many disparate criteria in this type of treatment.
4) Regarding the two widely used classifications, Wagner and the University of Texas, where WIFI and PEDIS?: revised and modified.
5) What time intervals have been chosen for the reference articles, e.g. 2010 to 2022?: in the period between 2015 and 2022. The objective was to achieve the best update, taking into account important data from previously published articles.
6) What method of patient education is most effective? Carrying out schools for patients or one-on-one talks, training videos?: In this type of user, the most effective method is patient health education together with the family member or main caregiver.
7) The language is reviewed by the University's language department.
We hope that it is of your consideration.

Round 2

Reviewer 1 Report

The manuscript has been revised accurately.

Reviewer 2 Report

From my point of view, the paper got better.