Implant healing in experimental animal models of diabetes.
Abstract
Diabetes mellitus is becoming increasingly prevalent worldwide. Additionally, there
is an increasing number of patients receiving implantable devices such as glucose
sensors and orthopedic implants. Thus, it is likely that the number of diabetic patients
receiving these devices will also increase. Even though implantable medical devices
are considered biocompatible by the Food and Drug Administration, the adverse tissue
healing that occurs adjacent to these foreign objects is a leading cause of their
failure. This foreign body response leads to fibrosis, encapsulation of the device,
and a reduction or cessation of device performance. A second adverse event is microbial
infection of implanted devices, which can lead to persistent local and systemic infections
and also exacerbates the fibrotic response. Nearly half of all nosocomial infections
are associated with the presence of an indwelling medical device. Events associated
with both the foreign body response and implant infection can necessitate device removal
and may lead to amputation, which is associated with significant morbidity and cost.
Diabetes mellitus is generally indicated as a risk factor for the infection of a variety
of implants such as prosthetic joints, pacemakers, implantable cardioverter defibrillators,
penile implants, and urinary catheters. Implant infection rates in diabetic patients
vary depending upon the implant and the microorganism, however, for example, diabetes
was found to be a significant variable associated with a nearly 7.2% infection rate
for implantable cardioverter defibrillators by the microorganism Candida albicans.
While research has elucidated many of the altered mechanisms of diabetic cutaneous
wound healing, the internal healing adjacent to indwelling medical devices in a diabetic
model has rarely been studied. Understanding this healing process is crucial to facilitating
improved device design. The purpose of this article is to summarize the physiologic
factors that influence wound healing and infection in diabetic patients, to review
research concerning diabetes and biomedical implants and device infection, and to
critically analyze which diabetic animal model might be advantageous for assessing
internal healing adjacent to implanted devices.
Type
Journal articleSubject
AnimalsBiosensing Techniques
Blood Glucose
Blood Glucose Self-Monitoring
Candidiasis
Cross Infection
Cytokines
Defibrillators, Implantable
Diabetes Complications
Fibrosis
Humans
Intercellular Signaling Peptides and Proteins
Orthopedics
Prostheses and Implants
Prosthesis Failure
Wound Healing
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https://hdl.handle.net/10161/9195Published Version (Please cite this version)
10.1177/193229681100500315Publication Info
Le, NN; Rose, MB; Levinson, H; & Klitzman, B (2011). Implant healing in experimental animal models of diabetes. J Diabetes Sci Technol, 5(3). pp. 605-618. 10.1177/193229681100500315. Retrieved from https://hdl.handle.net/10161/9195.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Bruce Klitzman
Associate Professor in Surgery
Our overriding interests are in the fields of tissue engineering, wound healing, biosensors,
and long term improvement of medical device implantation. My basic research interests
are in the area of physiological mechanisms of optimizing substrate transport to tissue.
This broad topic covers studies on a whole animal, whole organ, hemorheological, microvascular,
cellular, ultrastructural, and molecular level. The current projects include:
1) control of blood flow and flow distribu
Howard Levinson
Associate Professor of Surgery
Fibrosis Wound Healing Cell Contractility Tissue RemodelingMedical device development
including hernia mesh, tissue engineered skin and wound care technologies
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