Liesel-Ann Meusel¹, PhD, Ekaterina Tchistiakova^2,3, BSc, William Yuen^4,5, BSc, Bradley J Macintosh^2,3, PhD, Nicole D Anderson^1,6, PhD, and Carol E Greenwood^4,5, PhD
¹Rotman Research Institute, Baycrest Centre, Toronto, ON. ²HSF Centre for Stroke Recovery, Sunnybrook Research Institute, Toronto, ON. ³Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON.
⁴Kunin-Lunenfeld Applied and Evaluative Research Unit, Baycrest Centre, Toronto, ON. ⁵Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON. ⁶Departments of Psychology and Psychiatry, University of Toronto, Toronto, ON.

Abstract
Type 2 diabetes mellitus is increasingly common, and previously unrecognized complications are emerging; namely, cognitive impairment and dementia. The mechanisms that link these factors together are still unknown, but likely result from the interplay of several variables, including vascular change, poor glycemic control, inflammation, and hypothalamic pituitary adrenal overactivity. At present, it is still too early to propose best practices related to the management of diabetes-induced cognitive change. All things considered, however, patients should be aware that proper management of metabolic and vascular complications may minimize the adverse effects of type 2 diabetes on cognitive function and quality of life.
Keywords: type 2 diabetes, cognition, dementia, vascular, metabolic.

Madhuri Reddy, MD, MSc, FRCPC, Assistant Professor, Department of Medicine,
University of Toronto, Associate Editor, Geriatrics & Aging, Toronto, ON.

R. Gary Sibbald, BSc, MD, FRCPC (Med), FRCPC (Derm), MACP, DABD, Associate Professor and Director of Continuing Education, Department of Medicine, University of Toronto, Toronto, ON.

Prevention of diabetic foot wounds is of crucial importance. Diabetic foot wounds are basically pressure ulcers due to improper footwear, and therefore the most critical aspect of prevention is wearing proper shoes, checked regularly by a reputable orthotist. Once foot wounds have occurred in a person with diabetes, proper footwear continues to be
crucial. Also of importance are adequate vascular supply, treatment of infection, and surgical debridement, if necessary. All diabetic foot wounds should be probed in order to evaluate depth. If the wound probes to bone, osteomyelitis should be presumed unless proven otherwise.

Key words: diabetes, wounds, ulcers, vascular, infection.