Diabetes

Medical misdiagnosis is common and can be caused by errors in clinical reasoning that arise from knowledge deficits, cognitive biases, and dual-process thinking.1 Dual process thinking is a generally accepted conceptualization of clinical reasoning that includes an initial intuitive assessment followed by a slower logical analysis. Misdiagnosis can arise during both of these evaluative processes.

Recent literature has established that there is much for the medical community to learn about highly pigmented skin, specifically in the realm of wound healing and even more so in diabetic foot ulcers (DFUs). Most distressing is the higher prevalence of amputation and mortality among patients with skin of color and DFUs as opposed to their Caucasian cohorts. In fact, a 2022 study found that patients identifying as Black were approximately 4% more likely to experience above-ankle amputation or death.

Diabetic foot ulcers (DFUs) are open sores or wounds caused by a combination of factors that include neuropathy (lack of sensation), poor circulation, foot deformities, friction or pressure, trauma, and duration of diabetes with complication risks. DFUs occur in 34% of people with diabetes, and approximately 14% to 24 % of patients with diabetes who develop a DFU will require an amputation.

The presence of more than one chronic condition in an individual is often referred to as comorbidity. Various comorbidities can interfere with, or inhibit, wound healing processes.

Patients who are immunocompromised present a unique and difficult challenge when considering wound care and healing. These patients may include children, older adults, organ transplant recipients, patients with cancer, those with diabetes mellitus, or those with HIV/AIDS. Immunocompromised patients are at increased risk of hypothermia, infection, and otherwise poorly healing or recurrent wounds. Many treatments for infection and interventions to promote wound healing rely on a properly functioning immune system. In immunocompromised patients, alternate treatment methods are needed to compensate for the impairments in their natural immune response.