The first investigations on the efficacy of oxygen in treating disease occurred from 1798 to 1800 at the Pneumatic Institution in Bristol, U.K., and it is possible that this is where the first oxygen inhalation treatment for a DFU was given. In 1775, Joseph Priestley tested his discovered dephlogisticated air (later called oxygen by Lavoisier) on himself and wrote, “The feeling of it in my lungs was not sensibly different from that of common air, but I fancied that my breast felt peculiarly light and easy for some time afterwards” ( 10, 11). ![]() Because the rate of oxygen delivery is inversely proportional to the square of the distance and directly proportional to the partial pressure of oxygen (Po 2) at the initial point at the capillary, these consequences lead to reduced oxygen delivery capacity and increased risk of clinically significant ischemia. These changes result in diminished blood flow, decreased oxygen tension, tissue edema, and subsequent capillary rarefaction. The consequences of the capillary basement membrane thickening with endothelial hypertrophy, increased permeability, and decreased responsiveness to environmental and physical changes are frequently present in people with DFUs. Microvascular dysfunction is an even more treacherous companion to diabetes, as it progresses over a long time and engages all organ systems. Macrovascular disease tends to occur at a younger age and engages more distal vessels in people with diabetes. It is mandatory to evaluate peripheral circulation early in the course of DFU treatment, as an open or endovascular procedure might restore the vascular and oxygen-delivering capacity to a level conducive to ulcer healing. In diabetes, macrovascular and microvascular disease contribute to impaired blood circulation in the lower extremities. Thus, we fear a tsunami of diabetes and its late complications in the next decade. An 80% reduction in A1C testing was reported in April 2020 in the first 6 months of the pandemic, an estimated 1.4 million A1C tests were missed for routine monitoring of glycemic control, and >5 million more tests were missed for the diagnosis of diabetes. Our pessimism regarding this possible impact is supported by a recent study from the United Kingdom which, using A1C as a surrogate, estimated the effect of the pandemic on diabetes diagnosis and management ( 4). However, depressing though these data are, they do not take into account the impact the current global coronavirus disease 2019 (COVID-19) pandemic will likely have on the worldwide prevalence of diabetes and its complications. The past 2 years have seen a 16% increase in the global prevalence of diabetes, with one in 10, or >537 million, adults now having the disease. ![]() At the time of writing, the International Diabetes Federation had just published the 10th edition of its IDF Diabetes Atlas ( 3), which, in many ways, makes for depressing reading.
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