Can we link foot ulcer with risk factors in diabetics? A study in a tertiary care hospital

Khan, Muhammad Imran; Azhar, Usama; Zubair, Fizza; Khan, Zohaib Abbas

doi:10.12669/pjms.346.16199

Cited by 24 publications

(30 citation statements)

References 15 publications

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“…Patients with DFUs were significantly overweight, have nonsignificantly lower mean arterial BP, and have high fasting serum glucose. Our findings are in agreement with Khan et al's study which found that greater BMI is significantly associated with foot ulcer while high BP or T2D is insignificantly linked to FUs [18]. Significantly high red cell distribution width value in DFUs is in agreement with other studies that demonstrated that high RDW is a marker of complicated T2D [8, 19].…”

Section: Discussionsupporting

confidence: 93%

Utility of Tetrahydrobiopterin Pathway in the Assessment of Diabetic Foot Ulcer: Significant and Complex Interrelations

Al-Nimer

Ratha

Mahwi

2019

Journal of Diabetes Research

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Objectives. Tetrahydrobiopterin (BH4) pathway that included generation of neopterin (Neop), biopterin (Biop), and nitric oxide (NO) is altered in type 2 diabetes (T2D). The aim of this study was to assess the biomarkers of BH4 pathway in noninfected DFUs and to relate these levels to the variables of diabetes as well as to the hematological indices. Methods. We performed a cross-sectional investigating study in a Kurdish people including 30 healthy subjects (group I), 66 T2D patients (group II), and 57 DFUs patients (group III). Hematological indices including red cell distribution width (RDW), mean platelet volume (MPV), and platelet distribution width (PDW) were determined by Coulter hematological analysis. Serum BH4 markers including NO, Neop, and Biop were determined by using an enzyme-linked immunosorbent assay (ELISA) technology. The relationship between BH4 markers with glycemic and hematological indices was assessed by Spearman’s correlation and multivariable regression analysis. Results. Neop was significantly increased while PDW was significantly decreased in group III compared with group II patients. Nitric oxide was found to be inversely correlated with age (r=−0.382), duration of diabetes (r=−0.264), mean arterial blood pressure (r=−0.532), body mass index (r=−0.321), RDW (r=−0.322), and PDW (r=−0.284) in group III patients. Circulating Neop and Biop significantly correlated with RDW and erythrocyte sedimentation rate. Multivariable regression analysis revealed that serum Neop predicted the DFUs in 92.5% of group III patients. Conclusion. Tetrahydrobiopterin biomarkers are predictors of DFUs and the significant correlation of neopterin with red distribution width and erythrocyte sedimentation rate indicating the role of neopterin in the vascular and inflammation concerns of noninfected DFUs.

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Section: Discussionsupporting

confidence: 93%

Utility of Tetrahydrobiopterin Pathway in the Assessment of Diabetic Foot Ulcer: Significant and Complex Interrelations

Al-Nimer

Ratha

Mahwi

2019

Journal of Diabetes Research

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“…In this study, patients with diabetes taking combined medication (insulin and oral hypoglycemic agents) were 89% less likely to develop diabetic foot ulcers compared to patients with diabetes taking oral hypoglycemic agents. This contradicts with research findings conducted in: Iraq, with a cross-sectional study that showed that using a combination of insulin and oral antidiabetic agents were significantly associated with the development of DFUs, 30 Pakistan, with a cross-sectional study that states that a combination of both insulin and oral hypoglycemic agents was strongly associated with the development of diabetic foot ulcers, 19 Malaysia, with a case–control study that showed combination of both insulin and oral hypoglycemic agents were not significantly associated with DFU, 29 and Eastern Indonesia, with a case control study that states taking both insulin and oral hypoglycemic agents were not significantly associated with DFU. 18 The possible reason for this discrepancy could be due to differences in condition of the diabetes mellitus among the study participants.…”

Section: Discussionmentioning

confidence: 76%

“…Structured questionnaire adapted from different similar literature, [7][8][9][18][19][20] and standard evaluation tools for diabetic foot ulcers [21][22][23][24] were used to collect data. An intervieweradministered structured questionnaire and medical chart reviewing were carried out to collect data from the cases and controls.…”

Section: Data Collection Tools and Proceduresmentioning

confidence: 99%

<p>Determinants of Diabetic Foot Ulcer Among Adult Patients with Diabetes Attending the Diabetic Clinic in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: Unmatched Case–Control Study</p>

Woldemariam¹,

Tadele²,

Radie³

et al. 2020

DMSO

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Background: Diabetic foot ulcer is among the commonest complications of diabetic mellitus attributed to a number of morbidity and mortality cases in diabetic patients. Nowadays, the incidence of diabetic foot ulcer is increasing due to the increased prevalence of diabetes. However, the risk factors of the problem are less studied in Ethiopia. Hence, this study was conducted to assess the determinants of diabetic foot ulcer among adult patients with diabetes attending a diabetic clinic in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia in 2019. Patients and Methods: An institution-based unmatched case-control study was conducted on 161 patients with diabetes (53 patients with diabetes with foot ulcer and 108 patients with diabetes without foot ulcer). Cases were selected from patients with diabetes with foot ulcer by consecutive sampling technique and controls from patients with diabetes without diabetic foot ulcer by systematic random sampling technique. A binary logistic regression model was used to assess the association between the dependent and independent variables. All variables with a P-value<0.25 were included in the multivariable analysis. Statistical significance was declared at P-value<0.05 with 95% confidence interval. Results: In this study, 28 (52.8%) cases and 55 (50.9%) controls were male. Taking insulin alone (AOR=2.75, 95% CI=1.04-7.23), having peripheral neuropathy (AOR=7.56, 95% CI=2.82-20.24), not inspecting feet daily (AOR=5.61, 95% CI=2.24-14.05), and using moisturizing cream between toes (AOR=3.35, 95% CI=1.35-8.32) were positively associated with diabetic foot ulcer, whereas employed (AOR=0.35, 95% CI=0.14-0.87) and combined treatment (insulin and oral hypoglycemic agents) (AOR=0.11, 95% CI=0.02-0.57) were negatively associated with diabetic foot ulcer. Conclusion: Diabetic foot ulcer was significantly associated with occupation, kind of treatment of diabetes mellitus taking, peripheral neuropathy, inspecting feet daily, and putting moisturizing cream between toes. It will be helpful if diabetic patients inspect their feet on a daily basis and do not put moisturizing cream between their toes.

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“…No association with gender was retrieved in some studies evaluating this parameter [ 16 , 18 , 20 ]. A male gender was associated with a higher prevalence of diabetic foot ulcers or amputations in several studies [ 17 , 27 – 29 ]. Our results may be explained by a more advanced age, a higher prevalence of elevated WC, and probably a lower school level in women in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Elevated WC was associated in our study to higher risk groups. A high WC was demonstrated to be a risk factor for diabetic neuropathy [ 32 ] or for diabetic foot ulcers [ 27 , 28 ]. We could suggest the same mechanism for the elevated BMI.…”

Section: Discussionmentioning

confidence: 99%

Risk assessment for foot ulcers among Tunisian subjects with diabetes: a cross sectional outpatient study

et al. 2020

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Background: Diabetic foot is an underestimated and redoubtable diabetes complication. The aims of our study were to assess diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGD F) classification, stratify patients into risk categories and identify factors associated with higher-risk grade. Methods: Cross-sectional setting over a period of 07 months, patients were randomly selected from the diabetic outpatients attending our unit of diabetology. Questionnaire and clinical examination were made by the same physician. Patients free of active foot ulcer were included. Results: Among 230 patients evaluated, 10 had an active foot ulcer and were excluded. Five patients (2.27%) had a history of foot ulcer and 3(1.36%) had a lower-limb amputation. Sensory neuropathy, as measured by the 5.07(10 g) Semmes-Weinstein monofilament testing, was present in 23.63% of patients, whereas 36.82% had a peripheral arterial disease based on clinical findings, and 43.63% had foot deformities. According to the IWGDF classification, Group 0: 72.72%, Group 1: 5.9%, Group 2: 17.73% and Group 3: 3.63%. After univariate analysis, patients in higherrisk groups were significantly more often female, had higher age and BMI, longer diabetes duration, elevated waist circumference, low school level, retinopathy and hyperkeratosis. Multivariate logistic regression analysis identified 3 significant independent factors associated with high-risk groups: retinopathy (OR = 2.529, CI95 [1.131-5.655], p = 0.024), hyperkeratosis (OR = 2.658, CI95 [1.222-5.783], p = 0.014) and school level (OR = 0.489, CI95 [0.253-9.44], p = 0.033). Conclusions: Risk factors for foot ulceration were rather common in outpatients with diabetes. The screening of patients at risk for foot ulceration should start early, integrated with sustainable patient education.

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Can we link foot ulcer with risk factors in diabetics? A study in a tertiary care hospital

Cited by 24 publications

References 15 publications

Utility of Tetrahydrobiopterin Pathway in the Assessment of Diabetic Foot Ulcer: Significant and Complex Interrelations

Utility of Tetrahydrobiopterin Pathway in the Assessment of Diabetic Foot Ulcer: Significant and Complex Interrelations

<p>Determinants of Diabetic Foot Ulcer Among Adult Patients with Diabetes Attending the Diabetic Clinic in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: Unmatched Case–Control Study</p>

Risk assessment for foot ulcers among Tunisian subjects with diabetes: a cross sectional outpatient study

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