Introduction
Diabetes is more than a blood sugar issue. If uncontrolled, diabetes can contribute to poor vessel and nerve function, inflammation and circulation problems, difficulty healing wounds and renal/ cardiovascular issues over the long haul. This is why treating diabetes often requires more than just targeting glucose.
Double Filtration Plasmapheresis (DFPP) may be an option as supportive therapy for selected patients with high inflammatory burden, abnormal lipids, vascular risk or diabetes-related complications. In DFPP, blood is separated to remove plasma in which selected high molecular weight substances.
Note, DFPP is not a treatment for diabetes and should not be used as a substitute for standard treatment such as medicine, insulin, diet and exercise or medical advice. Rather, DFPP will be presented as a supplementary adjuvant strategy to help ameliorate biological risk factors that can potentially exacerbate diabetic complications.
What Is DFPP?
DFPP is an active process performed extracorporeally, or outside the body, where blood from a suitable donor is filtered by a medical device.
This includes a two-step filtration process:
Separation of plasma – blood cells from plasma
Plasma fractionation — larger unwanted components in the plasma are filtered out before plasma is returned
DFPP is well known in order to remove low-density lipoprotein (LDL) cholesterol, triglycerides, fibrinogen, immune complexes, some inflammatory proteins and other highmolecular-weight substances depending on the filter type and treatment goal. DFPP is a membrane-based apheresis technique for the removal of high-molecular-weight substances, and recent studies all report reductions in cholesterol fractions, triglycerides, lipoprotein(a) and C-reactive protein in hyperlipidemia patients.
Reasons why DFPP may be an option in the care of diabetes
The diabetes pathology generates a multifactorial internal atmosphere, such as elevated glucose, oxidative stress, inflammation, poor circulation syndromes combined with abnormal lipids and hyperviscosity blood status. They can play a role in the vicious cycle of complications — diabetic foot ulcers, peripheral vascular disease and neuropathy, kidney stress and even cardiovascular risk to name a few.
Diabetes research in the area of diabetic foot and blood rheology demonstrated that diabetes is connected with modifications in blood consistency and microcirculation, leading to an impact on tissue oxygenation and wound healing potential.
Conclusions: DFPP could be considered in selected diabetes patients due to its ability to decrease the concentration of pro-atherogenic and pro-inflammatory circulating factors, resulting in an alleviating effect on vascular and inflammatory burden.
Figure 1: Potential Role of DFPP in Reducing Vascular and Inflammatory Burden in Diabetes
Treatment of DFPP from Diabetes
Supporting Vascular Health
Most of diabetes-related complications are vascular. Inadequate blood flow means that less oxygen and nutrients get to tissues, particularly in the legs and feet, kidneys, eyes and nerves.
DFPP may potentially play a role in the maintenance of vascular function and blood flow characteristics in select patient populations by decreasing various lipid and plasma constituents. Donnes particuliers aux patients dexuhm de saxoplasie ou hypertension artneurelle, tariquesou auother.
Reducing Lipid Burden
Diabetes patients often have deranged lipid profiles; higher triglycerides, greater LDL-cholesterol and elevated cardiovascular risk. Little is known about the other biological marker including lipid parameters in particular DFPP and its direct impact on lipids because studies has suggest that, DFPP can contribute to lowering of some lipid components such as total cholesterol, low-density lipoprotein (LDL) or triglycerides and lipoprotein(a), while there are very few human data.
This does not obviate the need for lipid-lowering medication but may be useful in selected cases by clinical criteria such as High/Loss of control of lipids.
Improving Blood Rheology and Microcirculation
Blood rheology is a measure of the flow characteristics of blood. Such as bio-viscosity and microcirculation disturbance in diabetes may sometimes lead to tissue overloading stress state and wound healing impairment.
Rheopheresis is another double-filtration technique that has focused on diabetic foot syndrome related to hyperviscosity. This information may indicate that there exists a subset of patients with high-molecular-weight proteins which, if reduced, will improve plasma viscosity and enhance microcirculation.
Providing Support for Diabetic Foot and Wound Management
Diabetic foot ulcers present a challenge with regard to healing due to low tissue perfusion, nerve dysfunction and susceptibility to infection and inflammation as well as impaired tissue repair mechanisms. When vascular or inflammatory burden warrants, DFPP may be incorporated as an integral component of a comprehensive diabetic foot care strategy.
It should not be used alone. Even diabetic foot management would need wound assessment, infection control, offloading, debridement (where relevant), blood sugar management, vascular evaluation support and follow up.
Reducing Inflammatory Burden
Diabetes has a background of chronic inflammation, which reduces the ability to deal with both metabolic and vascular stress. In hyperlipidemia patients, some DFPP surge studies have documented decreases in inflammatory markers such as C-reactive protein following filtration.
Thus DFPP represents a possible therapeutic target in the supportive care of patients with metabolic inflammation and vascular complications.
DFPP Is Not a Comprehensive Solution for Treating Diabetes
DFPP does not treat diabetes, it is build a new pancreas or take the place of prescription medications. Glucose control is still the gold standard for diabetes treatment.
Complete diabetes treatment plan:
Medical diabetes management
Blood sugar and HbA1c monitoring
Nutrition planning
Physical activity when appropriate
Weight management
Lipid and blood pressure control
Kidney and cardiovascular monitoring
Foot care and wound prevention
DFPP only when medically appropriate
DFPP is a supportive procedure applied to reduce some specific risk factors, but not for treating diabetes itself.
Who is Eligible for DFPP?
This may be indicated to discuss DFPP for selected patients with diabetes:
High LDL cholesterol or triglycerides
High inflammatory burden
Diabetes-related vascular risk
Poor microcirculation
Diabetic foot complications
Severe metabolic stress
Cardiovascular risk factors
Resistant to standard lipid or vascular management
Each case must be carefully reviewed by a physician. DFPP cannot be performed in all diabetes patients.
Safety and Medical Considerations
Therefore, DFPP is only to be done in a well-organized medical environment by qualified personnel; sterile technique, monitoring and emergency facilities must be prepared for rapid intervention.
Before DFPP, patients may require:
Blood tests
Coagulation profile
Kidney and liver function tests
Lipid profile
Blood pressure assessment
Medication review
Vascular risk evaluation
Special precautions may be required in case of patients taking blood thinners, those suffering from unstable heart disease, active infection, severe anemia and bleeding risk or low blood pressure.
Conclusion
In select patients, DFPP with diabetes treatment may provide supportive adjunctive value by potentially reducing lipid burden, pro-inflammatory proteins, blood viscosity factors and vascular stress. The latter suggestions could be pertinent in diabetic complication such as peripheral vascular events, metabolic inflammation, cardiovascular risk and diabetic feet.
DFPP, however, should not be touted as a diabetes cure. The best way to think of it will be an adjunctive blood purification strategy within a Comprehensive Medical Care Plan!
In appropriate patients DFPP may serve to supplement vascular health, microcirculation and metabolic burden as adjunctive therapy applied in conjunction with standard diabetes treatment, wound care, lifestyle modifications and physician-guided clinical follow-up.