Diabetes is a common disease which has been estimated to affect up to 3~o of the population in Great Britain. This fact alone would make it an important disease for the orthopaedic surgeon because it is bound to occur as an incidental finding in many patients undergoing both emergency and "cold' orthopaedic procedures. The importance of diabetes is even greater--firstly because it occurs more frequently in the elderly poI~ulation who make up an increasing amount of orthopaedic practice, and secondly because there are a number of orthopaedic problems which are more common in diabetic patients and a few, such as 'the diabetic foot', which present problems unique to diabetics. In this review we will describe some of the recent changes in the understatrding and management of diabetes, then the metabolic abnormalities in diabetes and how these are relevant to the practical management of the diabetic patient who requires an orthopaedic procedure. Finally we will mention some of the conditions which present to the orthopaedic surgeon and are more commonly found in diabetics.
Recent Changes in Diabetic Management
The greatest change in the philosophy of management of diabetes has come from the mounting evidence that good diabetic control decreases the risk of diabetic complications. 1.2 This means that it is no longer considered adequate to maintain the diabetic symp~ torn-free but the aim has become the attainment of normoglycaemia. Many things have helped to achieve this goal but of particular note are:
- The introduction of diabetic specialist nurses to