Influence of metabolic dysregulation in pre ulcerative phase of diabetic foot

Abstract

Aim. To estimate the impact of metabolic disturbances in type 2 diabetic patients (T2DM) – glucose regulation, obesity, dyslipidemia, hypertension and risk for ulceration in the preulcerative phase of the diabetic foot syndrome (DFS). Materials and methods. In this prospective study 100 T2DM patients were evaluated for 1 year. The following parameters were estimated: duration, smoking habits, BMI, BP, HbA1c, TG, HDL, LDL, fundoscopy and measurements for risk score of DFS. Groups were stratified according to measurements : 0 – low risk, 1 – medium risk, 2- high risk, and 3 – very high risk. Results. Out of 100 patients, 53% were female and 47% male. Mean duration of T2DM was 10.47 ± 4.77 years. Diabetes duration up to 10 years included 52% of subjects and 48 % had a duration of more than 10 years. Forty-three percent were smokers , of which 77.4% were male and 22.6% female. Results of measurements for risk score stratifications are in visit 1 (V1): score 0 - 29 %, score 1 – 35%, score 2-18% and score 3 – 18% and after 12 months in visit 2 (V2) score 0- 17 %, score 1 – 39%, score 2-19% and score 3 – 25%. BMI was recorded as follows: normal (18 -25 kg/m2) 14%, overweight (25-30 kg/m2) 71% and obese (>30 kg/m2) 15% of patients. Mean HbA1c in V1 according the risk score is: 0 - =7.6%, 1- 7.9%, 2 – 8.5% and 3- 8.2% (p<0,005), and in V2: score 0- 7.26%, score 1-7.46%, score 2-7.54% and score 3-7.54%. Systolic BP categorical scores were measured: score 0 – 136 mmHg, 1 – 142 mmHg, 2 – 145 mmHg, 3 – 142 mmHg. Mean levels of TG scores were: 0-1.97 mmol/L, 1- 2.37 mmol/L, 2- 2.3 mmol/L, 3- 2.6 mmol/L. Mean levels of HDL: 0 – 1.06 mmol/L, 1 – 1.02 mmol/L, 2 – 0.97 mmol/L, 3 – 1,00 mmol/L. Mean levels of LDL: 0 – 3.69 mmol/L, 1 – 4.27 mmol/L, 2 – 4.05 mmol/L 3 – 4.09 mmol/L. Diabetic retinopathy (DR) in V1 was present with 68% - 53% non proliferative and 15% proliferative. In V2, DR was present in 72% of which 51% was nonproliferative and 21% proliferative. Conclusion: Suboptimal management of T2DM – high HbA1c, high BP, High TG and high LDL, are multiple factors for early appearance of DFS and have the impact of early progression from low to high score for foot ulceration. In T2DM, patients with duration more than 10 years , HbA1c>8%, TG>2.2 mmol/L, HDL<1.04 mmol/L , LDL>4 mmol/L have a high risk (2) or very high risk (3) score for ulceration.