Can Compression Socks Be Safely Used in Diabetics With Lower Extremity Edema?

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Lower extremity compression therapy was successfully used in diabetics with ankle brachial indices as low as 0.5.
Lower extremity compression therapy was successfully used in diabetics with ankle brachial indices as low as 0.5.

Use of mild compression diabetic socks may reduce ankle and calf circumferences in patients with diabetes and lower extremity (LE) edema, according to recent research published in Diabetes Research and Clinical Practice.

"Macro and microvascularity was not compromised in either group. Results of this study suggest that mild compression diabetic sock may be effectively and safely used in patients with diabetes and [LE] edema," Stephanie C. Wu, DPM, from the Center for Lower Extremity Ambulatory Research, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science in Chicago, Illinois, and colleagues wrote in their study.

Dr Wu and colleagues performed a double-blinded, randomized controlled trial of 80 patients with either diabetes or LE edema who wore either knee-high mild-compression diabetic socks (18-25 mm Hg) or noncompression knee-high diabetic socks during waking hours.

Patients were >18 years old and had mild or moderate LE edema, diabetes, toe brachial index (TBI) ³0.3, and ankle-brachial index (ABI) ³0.6, and were receiving clinical care at 1 of the 2 study sites at the Rosalind Franklin University Health System in Chicago and the Madigan Army Medical Center in Tacoma, Washington.

The researchers followed patients each week for 4 weeks, and 38 patients in the compression group and 39 patients in the control group reached final follow-up.

At each follow-up, researchers used bilateral ABI and TBI measurements as well as skin perfusion pressure, using laser Doppler to determine vascular status, and cutaneous fluid measurements and ankle, midfoot, and calf circumferences were used to measure edema.

"Subjects randomized to mild compression diabetic socks demonstrated a significant decrease in calf and ankle circumferences at the end of treatment as compared to baseline," Dr Wu and colleagues wrote in their study. "[LE] circulation was maintained in both groups throughout the study with no significant change in ABI, TBI, or [skin perfusion pressure] for either group."

Although there were no significant changes between groups, patients at the Chicago site had significantly higher ABI (mean difference, 0.264; 95% CI, 0.211-0.316) and TBI values (mean difference, 0.106; 95% CI, 0.034-0.178) compared with patients at the Tacoma site.

There were also significantly higher medial calf skin perfusion pressure values at the Tacoma site (mean difference, 6.77 mm Hg; 95% CI, 2.75-10.80).

"The findings of this double blind RCT [correlate] well with the results of the pilot study as well as with other studies that assessed the effects of mild compression in patients with concomitant [LE] edema secondary to venous insufficiency and [peripheral artery disease]," Dr Wu and colleagues wrote. "Compression therapy has been used successfully in patients with ABI as low as 0.5, and supervised reduced compression of 15-25 mm Hg has been advised for patients with an ABI between 0.5 and 0.85."

Reference

Wu SC, Crews RT, Skratsky M, et al. Control of lower extremity edema in patients with diabetes: Double blind randomized controlled trial assessing the efficacy of mild compression diabetic socks [published online February 26, 2017]. Diabetes Res Clin Pract. doi: 10.1016/j.diabres.2017.02.025

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