November has dual importance in the world of skin and wound care: it is a time to raise awareness about diabetes mellitus (DM; November is National Diabetes Month and November 14 is World Diabetes Day) and pressure injuries (PIs; Thursday, November 21 is World Wide PI Prevention Day). Dogs were used for key research discoveries in both.
Early work on the discovery of insulin started with a German scientist, Dr Paul Langerhans.1 He identified two types of pancreatic cells, including the Langerhans islet cells. Six years later, two other German investigators, Oskar Minkowski (a physiologist and pathologist) and Joseph von Mering (a physician) removed a dog’s pancreas, resulting in an elevated blood glucose and metabolic changes similar to the physiologic changes in a person with diabetes. In 1916, a Romanian physician from Bucharest, Nicolae Constantin Paulescu, isolated and injected aqueous pancreatic extract into a diabetic dog with a normalizing effect on blood sugar levels. Most scientists and clinicians are familiar with the work of Sir Frederick G. Banting (a Canadian orthopedic surgeon), Charles H. Best (his chemistry skills assistant), James B. Collip (who worked on the pancreas extract to purify it), and John James Richard Macleod (expert in carbohydrate metabolism), who completed further dog experiments between 1921 and 1923 that completed the knowledge translation cycle. They injected insulin into a young boy dying with type 1 DM at the Toronto General Hospital and saved his life! The rest is history; in 1923, Banting and Macleod received the Nobel Prize for the discovery of insulin.1
November 14, Dr Banting’s birthday, is World Diabetes Day. Can you do your part to identify persons with a high-risk foot and prevent foot ulcers and lower limb amputation? In this issue, a validated General Foot Screen is presented to help clinicians in their battle against DM. This screening tool can help detect persons with a high-risk foot who may not know they have diabetes. This is especially important because only 11.6% of adults with prediabetes know they are at risk; approximately 25% of persons with prediabetes will develop type 2 DM in 3 to 5 years, with up to 70% of persons with prediabetes developing DM during their lifetime.2
In contrast with DM, PIs have been observed clinically over several centuries. The classic work by Dr Michael Kosiak3 on dog thighs (1959) is often credited as breakthrough research into the etiology of pressure as the cause of PI. Each year, on the third Thursday of November, the global community pauses to raise awareness of PI. The National Pressure Ulcer Advisory Panel has many resources, including media materials, posters, buttons, drafts of proclamations, and clinical imagery that you can use to formulate a plan for prevention, educate the public, and celebrate this event at your insitution.4
Another key November PI event will be the launch of the third edition of the PI Clinical Guideline.5 The guidelines are the result of extensive collaboration of many healthcare professionals from numerous associations and stakeholders around the world who have synthesized current evidence into one document. If you cannot be in California for this landmark conference, be sure to go to the National Pressure Ulcer Advisory Panel website and download the guideline information once it is released.
Fortunately, the use of dogs in scientific research has decreased since the start of the century, commensurate with the increase in humane laws implemented around the world to protect man’s best friend.6 That said, we wish to congratulate the human researchers, clinicians, educators, and funders who continue to work together to provide the evidence and knowledge that results in improved patient outcomes.
Elizabeth A. Ayello, PhD, MS, BSN, RN, CWON, ETN, MAPWCA, FAAN
R. Gary Sibbald, MD, DSc (Hons), MEd, BSc, FRCPC (Med Derm), FAAD, MAPWCA, JM
2. Hostalek U. Global epidemiology of prediabetes—present and future perspectives. Clin Diabetes Endocrinol 2019;5:5.
3. Kosiak M. Etiology and Pathology of ischemic ulcers. Arch Phys Med Rehabil 1959: 62–69.