Rehabilitation nutrition in pressure ulcer management with type 2 diabetes: a case report

Yoko Saino ； Hidetaka Wakabayashi ； Keisuke Maeda ； Shinta Nishioka ； Takako Hao ； Kenji Mimatsu

《Asia Pacific Journal of Clinical Nutrition》 27卷3期 (2018/03) Pp. 728-734

https://doi.org/10.6133/apjcn.062017.05

摘要

Background and Objectives: Severe infection, inadequate food intake, and pressure ulcers in patients with type 2 diabetes can result in malnutrition. We describe a case in which rehabilitation nutrition was effective for treating a pressure ulcer in a malnourished patient with type 2 diabetes. Methods and Results: A 58-year-old man with type 2 diabetes was diagnosed with hidradenitis suppurativa on the left buttock and thigh and a severe pressure ulcer on his left kneecap. Malnutrition was related to hypermetabolism caused by chronic hidradenitis suppurativa and inadequate protein-energy intake before admission. We initiated a rehabilitation nutrition intervention to improve physical function and to treat a pressure ulcer by prescribing 2,000 kcal/day of food, including 80 g of protein, and physical rehabilitation for 40 minutes/day. The patient showed good progress in terms of his physical function and healing of the pressure ulcer. After prescribing 2,250 kcal/day of food, including 85 g of protein, and physical rehabilitation for 60 minutes/day, HbA1c levels increased to 7.4%. The energy prescription was decreased to 2,000 kcal/day to improve glycemic levels. Then, the patient’s weight decreased and his hand grip strength became weaker. On day 134 and discharge the patient could walk independently with a t-cane and ankle supporter. By day 14 after discharge, the pressure ulcer had epithelialized. Conclusion: Rehabilitation nutrition management improved physical function and facilitated pressure ulcer healing in a malnourished patient with type 2 diabetes. Close conjoint management of hyperglycemia was also necessary.

關鍵字

nutritional intervention ； diabetes mellitus ； wound healing ； malnutrition ； physical function