Abstract
Objectives: Patients with Diabetic Kidney Disease (DKD) and foot ulcer have poor prognosis. However, no study have found association of diabetic foot ulcer (DFU) with diabetic kidney dysfunction and their co-existing risk factors. Materials and Methods: This cross sectional study collected the data for 10,680 patients for 15 years. All variables were analyzed biochemically and statistically by standardized methodology. Results: Levels of HbA1c, creatinine, systolic and diastolic blood pressures, microalbuminuria, spot urine protein, and spot urine protein to creatinine ratio were higher among the groups with foot ulcers (p-value < 0.0001 for all). Average ABI was observed to be lower among the groups demonstrating nephropathy and DKD (p=0.025 and 0.022 respectively. DFU was significantly associated with HTN (odds ratio 2.2; 95% CI 1.66 to 2.9; p < 0.0001), nephropathy (odds ratio 4.77; 95% CI 3.53 to 6.5; p < 0.0001) and DKD (odds ratio 4.77 and 6.83; 95% CI 4.6 to 10.2; p < 0.0001). HbA1c of 7.8% was 60% sensitive and 52% specific for the development of DFU. Creatinine of 1.2 mg/dl was 75% sensitive and 48% specific for DFU. Spot urine protein excretion from nephrons of 35 mg/dl was 88% sensitive and 90% specific for the development of DFU. Conclusion: Nephropathy/DKD are risk factors for the development of DFU. With optimal diabetes control, regular and routine assessment of the feet and early screening of diabetic patients for neuropathy, nephropathy, hypertension, dyslipidaemia and other diabetic complications are essential. Doi: 10.28991/SciMedJ-2021-0304-6 Full Text: PDF
Highlights
Diabetes mellitus is a global health problem
Out of 10,680 patients, 12% presented with Diabetic foot ulcer (DFU). 43% was hypertensive. 39% demonstrated nephropathy, while 15% was diagnosed as diabetic kidney disease (DKD)/chronic kidney disease (CKD)
We have investigated for the first time risk factors such as elevated HbA1c, elevated Blood pressure (BP) or HTN, microalbuminuria, spot urine protein, for the development of DFU in the presence of nephropathy and DKD
Summary
Diabetes mellitus is a global health problem. Diabetic foot ulcer (DFU) or diabetic foot infection (DFI) are the major cause of lower extremity amputations (LEA). More than 25% of diabetic patients suffer from foot amputations during their lifetime and more than 85% of lower extremity amputation are due to foot infections or ulcerations. Diabetes is the most common cause of preventable Charcot neuroarthropathy. Diabetic foot problems are considered a complex group of pathologies and known as “diabetic foot syndrome” (DFS), including both neuropathy and vasculopahty or vascular insufficiency [1,2,3]. Periodic neurological assessment and examination is essential with measurement of ankle brachial index (ABI) and for foot pulses
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