Complications In Diabetic Patients Research Articles

Analysis of Chromosomal Aberrations and Micronuclei in Type 2 Diabetes Mellitus Patients

Introduction: Type 2 diabetes mellitus is a metabolic disorder characterized by insulin resistance and disrupted insulin secretion. It is often linked to injuries, malfunction and failure of several organs in the long term. The elevated chromosomal disruptions and genetic complications in diabetic patients are due to the increased production of reactive oxygen species.Materials and Methods: The current study used chromosomal aberration assay and micronucleus assay to analyze the extent of abnormalities in the subjects.Results: The results showed increase in frequency of chromosomal aberrations in diabetic patients when compared to the control group (2.76±1.65 and 0.47±0.75 respectively). They also showed higher levels of micronuclei formation than the control participants (13.28±8.63 and 4.12±8.89 respectively).The correlation analysis indicated positive relationship between total aberrations and duration of diabetes.Conclusion: These results indicate that diabetes is associated with genomic instability and studies at a genetic level can be employed for early detection.

Prevalence of Macrovascular complications in Diabetic Patients in Sohag Governorate: Sex Differences

Background: Atherosclerotic cardiovascular disease (ASCVD) is the major cause of death and disability in patients with type 2 diabetes. Objective: The aim of the research was to study the differences between male and female diabetic patients as regard the prevalence of macrovascular complications in Sohag Governorate, Upper Egypt. Methods: This Study was a cross sectional study on diabetes mellitus in Upper Egypt. The study included 500 diabetic patients randomly selected from rural and urban areas of Sohag Governorate. all patients were subjected to: history taking, clinical examination, blood pressure and pulse evaluation, ECG, echocardiography and laboratory investigations including blood glucose and HbA1c estimation. Results: 500 diabetics patients included in this study, 44.2% of them were males while 55.8% were females. one third of males were smokers and body mass index was statistically higher in females than males. No difference between male and female diabetics as regard control of diabetes or lipogram. The prevalence of hypertension, heart failure with reduced ejection fraction (HFrEF), and diastolic dysfunction were higher in males with significant difference. Peripheral arterial disease was higher in females while stroke was higher in males but with no significant difference. Conclusion: Macrovascular complications are prevalent among male and female diabetic patients. Hypertension, HFrEF and diastolic dysfunction were higher in males than females with significant difference.

Study of glycation process of human carbonic anhydrase II as well as investigation concerning inhibitory influence of 3-beta-hydroxybutyrate on it

Glycation is a non-enzymatic reaction between carbonyl groups in sugar and free amino groups in proteins. This reaction leads to changes in structure and functions of proteins in which the advanced glycation end products (AGEs) are the final outcome and cause many complications in diabetic patients. We herein examined the effect of fasting on the glycation process of human Carbonic anhydrase II under physiological conditions (37 °C and pH 7.4) employing various techniques, including Ultraviolet–visible spectroscopy, fluorescence spectroscopy and CD Spectroscopy. We found an increased 3-beta-hydroxybutyrate upon fasting. We studied various samples of control carbonic anhydrase (without glucose and 3-beta-hydroxybutyrate), carbonic anhydrase with glucose, carbonic anhydrase treated with 3-beta-hydroxybutyrate (BHB) and carbonic anhydrase along with glucose and 3-beta-hydroxybutyrate. The samples were incubated for 35 days under physiological conditions. Our results indicated that 3-beta-hydroxybutyrate inhibited the glycation process, decreased glucose binding to the protein, prevented the formation of AGEs, and modified the enzyme activity. Our findings would open new windows toward the enzymatic procedure which would have profound implication in understanding the diabetes mechanisms.

Correlational Study between Serum Vitamin-D Levels and Microvascular Complications in Diabetic Patients: A Tertiary Care Centre Experience from Western Uttar Pradesh

Correlational Study between Serum Vitamin-D Levels and Microvascular Complications in Diabetic Patients: A Tertiary Care Centre Experience from Western Uttar Pradesh

Porcine models for studying complications and organ crosstalk in diabetes mellitus.

The worldwide prevalence of diabetes mellitus and obesity is rapidly increasing not only in adults but also in children and adolescents. Diabetes is associated with macrovascular complications increasing the risk for cardiovascular disease and stroke, as well as microvascular complications leading to diabetic nephropathy, retinopathy and neuropathy. Animal models are essential for studying disease mechanisms and for developing and testing diagnostic procedures and therapeutic strategies. Rodent models are most widely used but have limitations in translational research. Porcine models have the potential to bridge the gap between basic studies and clinical trials in human patients. This article provides an overview of concepts for the development of porcine models for diabetes and obesity research, with a focus on genetically engineered models. Diabetes-associated ocular, cardiovascular and renal alterations observed in diabetic pig models are summarized and their similarities with complications in diabetic patients are discussed. Systematic multi-organ biobanking of porcine models of diabetes and obesity and molecular profiling of representative tissue samples on different levels, e.g., on the transcriptome, proteome, or metabolome level, is proposed as a strategy for discovering tissue-specific pathomechanisms and their molecular key drivers using systems biology tools. This is exemplified by a recent study providing multi-omics insights into functional changes of the liver in a transgenic pig model for insulin-deficient diabetes mellitus. Collectively, these approaches will provide a better understanding of organ crosstalk in diabetes mellitus and eventually reveal new molecular targets for the prevention, early diagnosis and treatment of diabetes mellitus and its associated complications.

Hydrogen sulfide mitigates myocardial inflammation by inhibiting nucleotide-binding oligomerization domain-like receptor protein 3 inflammasome activation in diabetic rats.

Inflammation plays a crucial part in hyperglycemia-induced myocardial damage. Hydrogen sulfide has been found to possess multiple biological activities in previous studies. This study investigated whether hydrogen sulfide conferred cardiac protection against damage in a diabetic rat model by inhibiting nucleotide-binding oligomerization domain-like receptor protein (NLRP) 3 inflammasome activation. Male animals were assigned to control, streptozotocin, streptozotocin + sodium hydrosulfide, and streptozotocin + DL-propargylglycine groups. Animals in the three streptozotocin groups were administrated 55 mg/kg streptozotocin by intraperitoneal injection. Streptozotocin + sodium hydrosulfide and streptozotocin + propargylglycine groups were treated with sodium hydrosulfide (56 μmol/kg) and propargylglycine (40 mg/kg), respectively, for four weeks. Estimation of fasting blood glucose, heart-weight/body-weight, cardiac function, and histopathological analysis, and measurement of myocardial enzymes were done to evaluate the degree of cardiac injury. In order to investigate the redox changes, the levels of total antioxidant capacity, malondialdehyde and lipid peroxidation, and the activities of superoxide dismutase, catalase, and glutathione peroxidase were assessed; the protein expression levels of Thioredoxin and Thioredoxin-interacting protein were measured in myocardial tissue. In addition, inflammatory reactions were assessed by measuring the concentration levels of interleukin-6, tumor necrosis factor-α, interleukin-1β, and interleukin-18 in serum and the expression levels of NLRP3 inflammasome complex-associated proteins in cardiac tissue. In the heart, hyperglycemia significantly induced cardiac dysfunction and injury, redox perturbation, and aggravation of inflammatory reactions. However, except for fasting blood glucose, treatment with sodium hydrosulfide significantly ameliorated these alterations, whereas treatment with propargylglycine further aggravated these alterations. This study highlights the protective properties of hydrogen sulfide against hyperglycemia-induced cardiac injury, and its possible mechanism was shown to involve negative regulation of Thioredoxin-interacting protein-mediated NLRP3 inflammasome activation. Impact statement Diabetic cardiomyopathy is a serious complication of diabetic patients, accompanied by chronic inflammation. The nucleotide-binding oligomerization domain-like receptor protein (NLRP) 3 inflammasome complex is involved in the progression of the inflammatory response of diabetes, including diabetic cardiomyopathy. Hydrogen sulfide (H2S) is a novel endogenous gas messenger. Several pieces of evidence have exhibited that H2S exerts anti-oxidant and anti-inflammatory activities against hyperglycemia-induced myocardial injury, but the mechanism remains unclear. The current study indicated that H2S protected the myocardium against hyperglycemia-induced injury by preventing Thioredoxin-interacting protein (TXNIP)-mediated NLRP3 inflammasome complex activation. The inhibition of TXNIP-mediated NLRP3 inflammasome complex would be an efficient therapy for H2S treatment in diabetic cardiomyocytes.

Vitamin D Deficiency and its Association with Nephropathy in Type 2 Diabetes Mellitus Patients: A Cross Sectional Study

Background: Vitamin D (VD) deficiency is linked to insulin activity and its release. It is associated with uncontrolled diabetes and more complications in diabetic patients. So, this study will prove importance of investigating serum VD level in Type 2 DM (T2DM) patients and its relation to complication of diabetic nephropathy. Materials and Methods: Total 1025 patients with Type 2 diabetes were enrolled in this study. Age limit was from 40 to 76 year. Investigations for serum VD, haemoglobin A1c (HbA1c), high-sensitivity C-reactive protein (hs-CRP) and urinary Albumin: Creatinine Ratio (ACR) were done in each patient. Result: It was found that most of the patient (77.89%) were having VD<29.88 ng/m along with significantly higher ACR and hs-CRP levels in these patients (P=0.012 and P=0.007, respectively). VD was observed significantly lesser in females than males P < 0.001. Those patients who were exposed to sunrays had significantly more VD values and lesser hs-CRP values in comparison to less-exposed ones, P-value (0.001 and <0.001), respectively. Physical activity significantly raises VD and decreases ACR levels in diabetic patients, P-value (0.045 and 0.001), respectively. Except age (r=0.356 P=0.041) all other factors like BMI (r=−0.503 P=0.008), duration of disease (r=−0.489 P=0.004), ACR (r=−0.295 P=0.016) and HbA1c (r=−0.330 P=0.031) were negatively correlated with VD. Conclusion: This study concluded that Type 2 diabetes with VD deficiency are prone for the development of nephropathy.

Gangrena u radu lekara opšte medicine

Introduction: Gangrene is a condition of necrosis and tissue death, mainly caused by poor circulation. If it`s not recognized and treated early on it may end fatally. It`s one of the most severe complications in diabetic patients and is caused by poor diabetes control. Gangrene is the leading cause of amputation in developed countries with a subsequent disability and an increased mortality rate. Most of all, it affects a patient`s life quality but it also has a huge impact on health and social system. Case report: Male, 63, presents with dilapidated, wet gangrene of the right foot. The patient is a long term diabetic, on insulin, and lives in the rural area. His PCP (primary care physician) suggested sending him to a hospital, but the patient refused and wanted to be treated at home. The treatment started with a local application of the alginate-argent compresses and oral and local antibiotic therapy. The wound was cleaned regularly and antibiotic ointment was applied. Sharp debridement of the callus was performed so we could use compressed hydrophilic polyurethane foams in the early phase of wound healing. After sixteen months of treatment, the wound healed completely. Conclusion: The patient was treated by the PCP team and we used all the up-to-date equipment used for the treatment of the chronic wounds. They are easily used in the PCP setting. The treatment was long and hard, mostly due to the patient`s unsatisfactory socio-epidemiological and economic conditions. Most importantly, the patient refused to cooperate fully with his PCP, which is the crucial precondition for successful treatment. The primary health care (PHC) is an irreplaceable part of every health system and it may play an important role not only in gangrene prevention but its treatment, as well.

A relationship between endoscopic findings and diabetic regulation, and complications in patients with diabetes mellitus

IntroductionDiabetes mellitus (DM) is the most common endocrine disease. Increasing with a rapid acceleration, DM affects the society both financially and socially with its possible complications. Dyspeptic complaints occur in approximately 40% of DM patients. Dyspepsia in DM is a difficult condition to treat and requires patients’ frequent hospital visits. We aimed to examine a relationship between diabetic regulation and diabetic complications as well as endoscopic findings in patients with DM and dyspeptic complaints.Material and methodsPatients with a DM diagnosis from internal diseases outpatient clinic of our hospital who were followed-up between January 2019 and June 2020, and who underwent endoscopy for the upper gastrointestinal system were included. Diagnosis of DM was made according to the American Diabetes Association (ADA) criteria. Diabetic complications were questioned. A relationship between endoscopic and histopathological findings, glycated hemoglobin (HbA1c) level, and complications was investigated.ResultsA total of 105 patients, 61 (58%) females, were included into the study. In a comparison between the groups, there was no statistically significant difference between glycemic regulation and endoscopic findings and the presence of HP. Comparing diabetic complications, no significant difference was observed in patients with complications from the endoscopic findings, except for pangastritis. The presence of HP was similar in both groups.ConclusionsIt can be said that endoscopic findings and presence of HP are not closely related to glycemic control and complications in diabetic patients. However, these results should be supported by larger, multi-center, prospective studies.

Early detection of foot complications using a thermal profiler of plantar surface

Foot complications in diabetic patients have become fatal, hence early detection is essential. Technique is being used by diabetologist at present is measurement of temperature variations in the plantar surface of the foot using thermogram images. This paper describes a novel approach called 'Thermal Profiler System' which profiles the temperature variations in the plantar surface. It consists of a device with 23 sensors, senses the temperature values of the plantar surface. It also consists of a mobile application to capture the temperature data, computes the variations in the temperature values and reports abnormalities to the diabetologist. An experimental study is conducted to validate the values recorded by the device. This study includes temperature data of subjects captured using a Thermal Profiler device is compared with the temperature data obtained from thermogram images. The statistical analysis shows there is no significant difference between the thermal profiler values and the thermogram images.

Glucose time in range and peripheral neuropathy in type 2 diabetes mellitus and chronic kidney disease

​ObjectiveCompared with hemoglobin A1c (HbA1c), continuous glucose monitoring (CGM) may better capture risk of diabetes complications in patients with chronic kidney disease (CKD), including diabetic peripheral neuropathy (DPN). We hypothesized...

Early detection of foot complications using a thermal profiler of plantar surface

Foot complications in diabetic patients have become fatal, hence early detection is essential. Technique is being used by diabetologist at present is measurement of temperature variations in the plantar surface of the foot using thermogram images. This paper describes a novel approach called 'Thermal Profiler System' which profiles the temperature variations in the plantar surface. It consists of a device with 23 sensors, senses the temperature values of the plantar surface. It also consists of a mobile application to capture the temperature data, computes the variations in the temperature values and reports abnormalities to the diabetologist. An experimental study is conducted to validate the values recorded by the device. This study includes temperature data of subjects captured using a Thermal Profiler device is compared with the temperature data obtained from thermogram images. The statistical analysis shows there is no significant difference between the thermal profiler values and the thermogram images.

DESI-MSI and METASPACE indicates lipid abnormalities and altered mitochondrial membrane components in diabetic renal proximal tubules.

Diabetic kidney disease (DKD) is the most prevalent complication in diabetic patients, which contributes to high morbidity and mortality. Urine and plasma metabolomics studies have been demonstrated to provide valuable insights for DKD. However, limited information on spatial distributions of metabolites in kidney tissues have been reported. In this work, we employed an ambient desorption electrospray ionization-mass spectrometry imaging (DESI-MSI) coupled to a novel bioinformatics platform (METASPACE) to characterize the metabolome in a mouse model of DKD. DESI-MSI was performed for spatial untargeted metabolomics analysis in kidneys of mouse models (F1 C57BL/6J-Ins2Akita male mice at 17weeks of age) of type 1 diabetes (T1D, n = 5) and heathy controls (n = 6). Multivariate analyses (i.e., PCA and PLS-DA (a 2000 permutation test: P < 0.001)) showed clearly separated clusters for the two groups of mice on the basis of 878 measured m/z's in kidney cortical tissues. Specifically, mice with T1D had increased relative abundances of pseudouridine, accumulation of free polyunsaturated fatty acids (PUFAs), and decreased relative abundances of cardiolipins in cortical proximal tubules when compared with healthy controls. Results from the current study support potential key roles of pseudouridine and cardiolipins for maintaining normal RNA structure and normal mitochondrial function, respectively, in cortical proximal tubules with DKD. DESI-MSI technology coupled with METASPACE could serve as powerful new tools to provide insight on fundamental pathways in DKD.

May C-peptide index be a new marker to predict proteinuria in anemic patients with type 2 diabetes mellitus?

C-peptide is a reliable marker of beta cell reserve and is associated with diabetic complications. Furthermore, HbA1c level is associated with micro- and macro-vascular complications in diabetic patients. HbA1c measurement of diabetic patients with anemia may be misleading because HbA1c is calculated in percent by taking reference to hemoglobin measurements. We hypothesized that there may be a relationship between C-peptide index (CPI) and proteinuria in anemic patients with type 2 diabetes mellitus (T2DM). Therefore, the aim of the present study was to investigate the association between C-peptide levels and CPI in anemic patients with T2DM and proteinuria. The patients over 18 years of age with T2DM whose C-peptide levels were analyzed in Endocrinology and Internal medicine clinics between 2014 and 2018 with normal kidney functions (GFR>60 ml/min) and who do not use any insulin secretagogue oral antidiabetic agent (i.e. sulfonylurea) were enrolled into the study. Hemoglobin levels were present in 342 patients with T2DM. Among these 342 cases, 258 (75.4%) were non-anemic whereas 84 (24.6%) were anemic. The median DM duration of the anemic group was statistically significantly higher in T2DM (p=0.003). There was no statistically significant difference found in proteinuria prevalence between non-anemic and anemic patient groups (p=0.690 and p=0.748, respectively). Anemic T2DM cases were corrected according to the age, gender, and duration of DM. C-peptide and CPI levels were not statistically significant to predict proteinuria (p=0.449 and p=0.465, respectively). The present study sheds light to the association between C-peptide, CPI, and anemic diabetic nephropathy in T2DM patients and indicates that further prospective studies are needed to clarify this issue.

The Role of MicroRNAs in the Pathogenesis of Diabetic Nephropathy.

Diabetic nephropathy (DN) is one of the most common microvascular complications in diabetic patients; it is also an important cause of renal dysfunction, renal fibrosis, and end-stage renal disease. Unfortunately, the pathogenesis of DN is complex and has not yet been fully elucidated; hence, the pathogenesis of DN to determine effective treatments of crucial importance is deeply explored. Early DN research focuses on hemodynamic changes and metabolic disorders, and recent studies have shown the regulatory role of microRNAs (miRNAs) in genes, which may be a new diagnostic marker and therapeutic target for diabetic nephropathy. In this review, we summarize the recent advances in the clinical value and molecular mechanisms of miRNAs in DN, providing new ideas for the diagnosis and treatment of DN.

Transplantation of PEGylated islets enhances therapeutic efficacy in a diabetic nonhuman primate model.

Islet cell transplantation can lead to insulin independence, reduced hypoglycemia, and amelioration of diabetes complications in patients with type 1 diabetes. The systemic delivery of anti-inflammatory agents, while considered crucial to limit the early loss of islets associated with intrahepatic infusion, increases the burden of immunosuppression. In an effort to decrease the pharmaceutical load to the patient, we modified the pancreatic islet surface with long-chain poly(ethylene glycol) (PEG) to mitigate detrimental host-implant interactions. The effect of PEGylation on islet engraftment and long-term survival was examined in a robust nonhuman primate model via three paired transplants of dosages 4300, 8300, and 10000islet equivalents per kg body weight. A reduced immunosuppressive regimen of anti-thymocyte globulin induction plus tacrolimus in the first posttransplant month followed by maintenance with sirolimus monotherapy was employed. To limit transplant variability, two of the three pairs were closely MHC-matched recipients and received MHC-disparate PEGylated or untreated islets isolated from the same donors. Recipients of PEGylated islets exhibited significantly improved early c-peptide levels, reduced exogenous insulin requirements, and superior glycemic control, as compared to recipients of untreated islets. These results indicate that this simple islet modification procedure may improve islet engraftment and survival in the setting of reduced immunosuppression.

Rising prevalence of diabetes: evidence from the national registry in North Macedonia

Abstract Background Disease reporting and data collection are key tools for the health care systems in order to identify opportunities to address burden of diseases. The country’s diabetes patients register was the first registry to be integrated with the e-health system in North Macedonia in 2017. We aimed to estimate type 2 diabetes mellitus prevalence and effectiveness of diabetes control as one of the proposed national priorities in tackling the non-communicable diseases. Methods Cross-sectional descriptive study was conducted on patients entered in the National Diabetes Register in 2017/2018. Patients’ socio-demographic and anthropometric characteristics in association with diabetes’ complications and outcomes were determined by Pearson correlation coefficient (P &amp;lt; 0.0001, 95% CI). Results This study identified a total of 35541 patients with a diagnosis of diabetes, out of which 32888 with type 2. This corresponds to a prevalence rate of 1583.9 per 100,000 population. The prevalence increased with age (65+) and was higher among females than males (56.8% vs. 43.2%). Over 80% of type 2 patients were overweight out of which 34.5% obese (BMI&amp;gt;30kg/m2). Diabetic retinopathy is reported as first diagnosed complication in diabetic patients, followed by neuropathies and vascular complications. Patient’s low level of education and higher BMI were associated with increased number of early and late-onset complications. Conclusions Evidence accumulating suggests high burden of complications in type 2 diabetic patients, indicating that the patients understanding of diabetes care, treatment adherence and healthy lifestyle are important topics to be address by health professionals in order to avoid complications and premature deaths in people with diabetes. Key messages Integrated reporting of non-communicable diseases and risk factors is needed to complete current information gaps, from completeness of data to quality and comparability. The action plan for chronic diseases should specifically address diabetes control, as most of the patients with diabetes have high prevalence of comorbidities, complications and unfortunate outcomes.

Delayed Gastric Emptying Associates With Diabetic Complications in Diabetic Patients With Symptoms of Gastroparesis.

Diabetic gastroparesis (Gp) occurs more often in type 1 diabetes mellitus (T1DM) than in type 2 diabetes mellitus (T2DM). Other diabetic end-organ complications include peripheral neuropathy, nephropathy, and retinopathy (together termed triopathy). This study determines the prevalence of diabetic complications (retinopathy, nephropathy, and peripheral neuropathy) in diabetic patients with symptoms of Gp, assessing the differences between T1DM and T2DM and delayed and normal gastric emptying (GE). Diabetic patients with symptoms of Gp underwent history and physical examination, GE scintigraphy, electrogastrography with water load, autonomic function testing, and questionnaires assessing symptoms and peripheral neuropathy. One hundred thirty-three diabetic patients with symptoms of Gp were studied: 59 with T1DM and 74 with T2DM and 103 with delayed GE and 30 without delayed GE. The presence of retinopathy (37% vs 24%; P = 0.13), nephropathy (19% vs 11%; P = 0.22), and peripheral neuropathy (53% vs 39%; P = 0.16) was not significantly higher in T1DM than in T2DM; however, triopathies (all 3 complications together) were seen in 10% of T1DM and 3% of T2DM (P = 0.04). Diabetic patients with delayed GE had increased prevalence of retinopathy (36% vs 10%; P = 0.006) and number of diabetic complications (1.0 vs 0.5; P = 0.009); however, 39% of diabetic patients with delayed GE did not have any diabetic complications. In diabetic patients with symptoms of Gp, delayed GE was associated with the presence of retinopathy and the total number of diabetic complications. Only 10% of patients with T1DM and 3% of those with T2DM had triopathy of complications, and 39% of diabetic patients with Gp did not have any diabetic complications. Thus, the presence of diabetic complications should raise awareness for Gp in either T1DM or T2DM; however, diabetic Gp frequently occurs without other diabetic complications.

Diabetic Ankle Fracture Complications: A Meta-Analysis

Category:Ankle, Diabetes, TraumaIntroduction/Purpose:Fractures in diabetic patients have a well-known increased risk of complications and this makes the decision to treat these fractures either surgically or conservatively a difficult choice. However, ankle fractures are mostly treated surgically because of their pattern and the postoperative management does not differ from those ankle fractures in non-diabetic patients.The following study aims to review the evident rate of complications following the treatment of an ankle fracture in diabetic patients and their matched controls.Methods:Searches of PubMed, Scopus, Cochrane and ISI Web of Knowledge were performed for studies published between the date of database inception and March 2018. An initial selection of 202 abstracts was performed by at least 2 different reviewers, of which 77 articles were selected to complete review. After following strict inclusion and exclusion criteria, only 17 papers were admitted to the final meta-analysis.Demographics patient characteristics and incidence of the overall and specific complications were extracted from each study selected and an odds ratio with a 95% confidence interval of each complication was calculated between the diabetic and non- diabetic groups.Major complications (infection, non-union, malunion, Charcot neuroarthropathy, amputation, death) were compared not only between the two main groups but also between subgroups (complicated diabetic and non-complicated diabetic patients, surgical and orthopaedic treatment).The statistics data was analysed by Stata 15.Results:There is a significant increased rate of complications after treating an ankle fracture orthopaedically or surgically in diabetic patients (OR 1.74, IC 95% 1.67 to 1.82). This risk is considerably higher when the ankle fracture is treated surgically (OR 5.14, IC 95% 2.79 -9.58). Among the complications in diabetic patients, the rate is greater in complicated diabetic patients (neuropathy, vasculopathy) compared to the non-complicated diabetic patients (OR 8, IC 95% 2.61 - 26.31).The main complication postoperative in ankle fracture described is infection, which is 7 times higher in diabetic patients in comparison to non-diabetic patients (OR 6.9, IC 95% 3.03 -15.73). The risk of amputation and/or non-union after an ankle fracture in diabetic patients is about 0.2%.Conclusion:This meta-analysis provides evidence that diabetic patients have a significant greater risk of presenting a complication after an ankle fracture. The rate of major complications (infection, malunion, non-union, amputation and death) is by far significantly higher among those diabetic patients treated surgically and even greater among complicated diabetic patients.

Elevated Preoperative Hemoglobin A1c Associated with Increased Wound Complications in Diabetic Patients Undergoing Primary, Open Carpal Tunnel Release.

An increased rate of complications has been demonstrated with increasing hemoglobin A1c value for a variety of orthopedic procedures, including arthroplasty and spine surgery. The authors investigated the effects of elevated hemoglobin A1c value on postoperative complications at the time of carpal tunnel release. This retrospective, cohort study evaluated all diabetic patients with a preoperative hemoglobin A1c value within 90 days of primary, open carpal tunnel release at a single academic institution within the past 10 years. Binary hemoglobin A1c thresholds were tested for association with outcomes of superficial or deep infection, delayed wound healing, and persistent symptoms using chi-square analysis. Multivariable models with adjustment for baseline and operative factors were then constructed. Odds ratios and 95 percent confidence intervals were displayed. Hemoglobin A1c value greater than or equal to 7.8 percent was most strongly associated with an increased risk of all-cause wound healing complications (p = 0.049) at an odds ratio of 4.2 (95 percent CI, 1.0 to 17.7) in adjusted analyses. Six patients (4 percent) experienced delayed wound healing and five patients (4 percent) developed a superficial infection. Six patients (4 percent) reported persistent carpal tunnel syndrome symptoms. Diabetic patients undergoing open, primary carpal tunnel release with a hemoglobin A1c value of 7.8 percent or higher had a higher rate of postoperative wound complications compared to diabetic patients with improved preoperative glucose control. Diabetics with poor glycemic control should be counseled that their risk of postoperative complication is higher. Further work is needed to determine whether delaying surgery to optimize glucose control could result in a reduction of wound healing complications. Risk, II.