Diabetic Foot Syndrome Patients Research Articles

Studying the C174g Polymorphism of The Il6 Gene in the Formation of Diabetic Foot Syndrome in Patients with Diabetes Mellitus

The criteria for risk stratification of the formation of diabetic foot syndrome in patients with diabetes mellitus based on the carriage of the interleukin 6 gene were studied. The clinical group included 96 patients aged 40 to 75 years with diabetes mellitus complicated by diabetic foot syndrome. The control group consisted of 83 healthy individuals. The results obtained by the authors demonstrate that the presence of the C/G genotype of the C174G polymorphism of the IL6 gene has a clear correlation with predisposition to the development of diabetic foot syndrome. In order to effectively prevent the development of diabetic foot syndrome, it is advisable to recommend genotyping of the C174G polymorphism in the IL6 gene

A study of the effect of gene polymorphism of xenobiotic biotransformation system, matrix metalloproteinases and interleukins on the development and course of distal neuropathy and diabetic foot syndrome in patients with type 1 and type 2 diabetes mellitus

Aim to improve the effectiveness of early diagnosis, prediction and therapy of distal neuropathy (DN) and diabetic foot syndrome (DFS) in patients with type 1 and type 2 diabetes by identifying the features of gene polymorphism of xenobiotic biotransformation systems and antioxidant protection, pro- and anti-inflammatory cytokines.
 Material and methods. The study group included 150 patients aged from18 to 70 years, men and women with type 1 and type 2 diabetes, having DN and DFS, and 20 healthy people. Research methods used in the study: 1) clinical objective research; 2) molecular genetic methods; 3) population-statistics methods.
 Results. In patients with type 1 and type 2 diabetes with DN and DFS, the significant differences were found between the frequency of occurrence of polymorphism variants: G681A(*2) the CYP2C19 gene (2 = 9.642, p = 0.008), (OR = 0.334, (95% CI 0.145-0.768)); A8202G of the MMP9 gene (2 = 7.589, p = 0.022), (OR =0.476, (95% CI 0.226-1.005)); IIe105Val of the GSTP gene (2 = 19.521, p = 0.000), (OR = 0.174, (95% CI 0.070-0.435)); G-1293C(c1/c2) of the CYP2E gene (2 = 15.996, p = 0.000), (OR = 0.163, (95% CI 0.034-0.772)).
 Conclusion. Among patients suffering from type 1 and type 2 diabetes with the genotype A/A polymorphism G681A(*2) of the CYP2C19 gene, the DN and SDS are 4 times more likely to develop. The G/G polymorphism genotype A8202G of the MMP9 gene increases the risk of developing DN and DFS by almost 2 times. The genotype G/G polymorphism IIe105Val of the GSTP gene in patients increases the risk of developing DN and DFS by 4 times. The variant of the genotype C/C polymorphism G-1293C(c1/c2) of the CYP2E gene increases the risk of DN and DFS by 5 times.

Genetic Predictors of Development of Diabetic Foot Syndrome in Patients with Diabetes Mellitus

An increase in the population of patients with diabetes mellitus affects the incidence of diabetic foot syndrome (DFS), as its chronic complication. Among the various types of growth factors that play a role in the development of late complications of diabetes, vascular endothelial growth factor, VEGF, is currently in the focus of attention. The study conducted by the authors was aimed at determining the relationship between the G634C polymorphism of the VEGFA rs2010963 gene and the predisposition to the development of diabetic foot syndrome in patients with diabetes mellitus. We examined 96 patients aged 39 to 76 years with diabetes mellitus complicated by diabetic foot syndrome. Based on the studies, it was determined that the G634C polymorphism in the VEGFA gene (rs2010963) is involved in the formation and development of diabetic foot syndrome in patients with diabetes mellitus.

Genetic Predictors of Development of Diabetic Foot Syndrome in Patients with Diabetes Mellitus

Genetic Predictors of Development of Diabetic Foot Syndrome in Patients with Diabetes Mellitus

Супутня ендокринна патологія у хворих на цукровий діабет 2-го типу та її вплив на ефективність лікування

Актуальність. Проблема поширеності коморбідної патології серед пацієнтів набуває нині все більшої актуальності. За умов коморбідності певні захворювання мають атиповий перебіг, підвищується ризик ускладнень, посилюється проблема поліпрагмазії, знижується прихильність пацієнтів до лікування. Мета: дослідити структуру та частоту супутньої ендокринної патології у хворих на цукровий діабет (ЦД) 2-го типу та її вплив на ефективність лікування. Матеріали та методи. У дослідженні взяли участь 2264 хворих на ЦД 2-го типу (1186 чоловіків та 1078 жінок), які протягом останніх п’яти років отримували медичну допомогу в умовах Українського науково-практичного центру ендокринної хірургії, трансплантації ендокринних органів і тканин. Досліджено частоту та структуру супутньої ендокринної патології у хворих на ЦД 2-го типу залежно від місця їх проживання, тривалості ЦД 2-го типу, індексу маси тіла (ІМТ), рівня глікованого гемоглобіну (HbА1с), медикаментозної тактики, наявності у хворого на ЦД 2-го типу інфаркту міокарда (ІМ), інсульту та синдрому діабетичної стопи (СДС). Результати. На частоту іншої ендокринної патології у хворих на ЦД 2-го типу не мають вірогідного впливу рівень HbА1с в осіб обох статей, наявність ІМ та інсульту у чоловіків, але мають суттєвий вплив територія проживання хворого, ІМТ та СДС у пацієнтів обох статей, помірний вплив — тривалість ЦД 2-го типу у хворих обох статей, ІМ та інсульт у жінок, на що слід зважати при веденні хворих на ЦД 2-го типу. Частота іншої ендокринної патології зростає при збільшенні ІМТ: у чоловіків — в 1,4 раза, у жінок — в 1,3 раза. Наявність у хворого на ЦД 2-го типу іншої ендокринної патології не справляє суттєвого впливу на ефективність лікування ЦД. Висновки. Потребує подальших наукових досліджень вивчення механізмів, які лежать в основі суттєво меншої частоти іншої ендокринної патології у хворих із СДС, суттєво більшої частоти іншої ендокринної патології у жінок, відсутності випадків дифузного зоба у жінок з ІМ та інсультом, поодинокі випадки — у чоловіків з ІМ та інсультом, а також більшої частоти первинного гіперпаратиреозу у хворих на ЦД 2-го типу з інфарктом міокарда.

Influence of therapy of negative pressure on microbial contamination of purulent-necrotic complications of diabetic foot syndrome

The aim — to study qualitative and quantitative indicators of microbial decontamination using negative pressure therapy in patients with purulent‑necrotic lesions of diabetic foot syndrome.Materials and methods. 107 medical cards of inpatient patients were analyzed, which during 2015 — 2016 were on inpatient treatment in surgical department number 1 of the 2nd city clinical hospital in Poltava with various forms of purulent necrotic lesions of diabetic foot syndrome. Type 2 diabetes had 89 (83.2 %) people, type 1 — 18 (16.8 %). The quantitative and qualitative parameters of the rate of microbial purification on the basis of regular cultures from purulent wounds were determined.Results and discussion. Microbial contamination before the start of local treatment in both groups was 105 — 107.On the 10th day in the patients of the main group in the treatment of which vacuum therapy was used, microbial associations were not detected, aerobic monoflora was sown in 5 (9.1 %) people, including 3 (60.0 %) — S. epidermidis, 2 (40.0 %) — S. aureus with a microbial number of 103. In the same comparison group, where the local treatment was used the traditional approach to local treatment of monoculture was found in 18 (34.6 %) persons, microbial associations — in 14 (26.9 %) Complete cleaning of the wound from microbial contamination using vacuum therapy in the treatment of suppurative‑necrotic complications of the diabetic foot syndrome in patients of the main group occurred until the 10th day, in patients of the 14th day of comparison.Conclusions. In the study, the positive effect of the use of negative pressure therapy on the rate and effectiveness of wound healing from microbial contamination of purulent‑necrotic complications of SDS has been proved, which makes it possible to reduce the duration of the appointment period for antibiotic therapy in patients in the main group. The average period of inpatient treatment in the main group was about 12 days, in the comparison group — 17. Such indicators inversely proportional to the cost of treatment for purulent‑necrotic lesions of diabetic foot syndrome.

Diabetic foot syndrome in patients with diabetes. A multicenter German/Austrian DPV analysis on 33870 patients.

The diabetic foot syndrome (DFS) is a serious complication in patients with diabetes increasing the risk for minor/major amputations. This analysis aimed to examine differences in diabetes patients with or without DFS stratified by type 1 (T1D) or type 2 diabetes (T2D). Adult patients (≥20y of age) with diabetes from the German/Austrian diabetes patients follow-up registry (DPV) were included. The cross-sectional study comprised 45722 subjects with T1D (nDFS =2966) and 313264 with T2D (nDFS =30904). In DFS, minor/major amputations were analysed. To compare HbA1C , neuropathy, nephropathy, cardiovascular disease risk factors, and macrovascular complications between patients with or without DFS, regression models were conducted. Confounders: age, sex, diabetes duration. In patients with DFS, a minor amputation was documented in 27.2% (T1D) and 25.9% (T2D), a major amputation in 10.2% (T1D) and 11.3% (T2D). Regression models revealed that neuropathy was more frequent in subjects with DFS compared with patients without DFS (T1D: 70.7 vs 29.8%; T2D: 59.4% vs 36.9%; both P<0.0001). Hypertension, nephropathy, peripheral vascular disease, stroke, or myocardial infarction was more common compared with patients without DFS (all P<0.0001). In T1D with DFS, a slightly higher HbA1C (8.11% vs 7.95%; P<0.0001) and in T2D with DFS a lower HbA1C (7.49% vs 7.69%; P<0.0001) was observed. One third of the patients with DFS had an amputation of the lower extremity. Especially neuropathy or peripheral vascular disease was more prevalent in patients with DFS. New concepts to prevent DFS-induced amputations and to reduce cardiovascular risk factors before the occurrence of DFS are necessary.

Diabetic neuropathy and risk of diabetic foot syndrome during implementation of the national protocol in management of diabetes

The implementation of unified clinical protocol (UCP) has set a target to primary care physicians (PCP) to identify the diabetic neuropathy and angiopathy, screening the risk of diabetic foot syndrome and its prevention. The aim of our research - to determine the frequency of diabetic neuropathy, the risk of diabetic foot syndrome and level of type 2 diabetes control in patients of Kyiv region in terms of implementation of new clinical protocol in type 2 diabetes management. Materials and methods. The reports of health establishments of Kiev region were analyzed and 173 patients with type 2 diabetes were examined (aged 55,13 ± 0,61 years): group 1 - observed by PCP (n=45), group 2 - by endocrinologists (n=128). Patients examination included laboratory tests of diabetes control and evaluation of the lower limbs by Neuropathy Disability Score and determination the "ankle-shoulder" index with the portable Doppler. Statistical analysis - Excel 2007, SPSS, Statistica 6.0. Results. Despite treatment, the average levels of blood glucose, HbA1c, lipidogramme exceeded target levels in patients with type 2 diabetes, indicating their lack of control. In this regard, at 7-9 years of the disease in 19.65% of patients were founeded signs of severe and in 36.42% - moderate diabetic neuropathy of the lower limbs and in 15.03% of patients - occlusion, leading to the development of diabetic foot syndrome in 9.82% of patients, and 70.52% of the patients had moderate (44.51%) or high (26.01%) risk of its development. The differences between patients of PCP and endocrinologists were not found. However, the significant decrease of neuropathy and angiopathy of lower limbs in patients with type 2 diabetes in the Kiev region and reducing the number of amputations for 2012-2014 demonstrates the positive effect of the implementation of UCP. Conclusion. The frequency of diabetic neuropathy and angiopathy of lower limbs, the number of amputations in Kiev region decreased, that indicates a positive effect of implementation of UCP, but the risk of diabetic foot syndrome in patients remains high due to inadequate control of type 2 diabetes by patients and PC physicians and specialists that require optimization.

Arterial diseases of lower extremities in diabetic patients: current state and prospects of therapy

Peripheral artery diseases (PAD) are most serious diabetic complications responsible for the high risk of amputation of lower extremities. The occurrenceof PAD in diabetic patients is much higher than in subjects with undisturbed carbohydrate metabolism. PAD in diabetic patients is frequentlyan asymptomatic condition affecting distal portions of arterial segments and associated with pronounced mediacalcinosis. Standard diagnostic proceduresfor the screening of arterial lesions must be supplemented by non-invasive visualization and measurement of transcutaneous oxygen tensionin patients at risk of PAD and persisting foot ulcers. Of special importance is early diagnosis of critical limb ischemia and prevention of foot lesions.Combined treatment of diabetic foot syndrome in patients with critical limb ischemia includes normalization of foot circulation, surgical interventionand conservative therapy of the wound, monitoring concomitant micro- and macrovascular diabetic complications?