Disease In Diabetic Patients Research Articles

Proton pump inhibitors use and risk of chronic kidney disease in diabetic patients

AimsChronic kidney disease consumes a huge amount of medical resources and proton pump inhibitors may be a potential factor for the increasing prevalence. This population-based cohort study investigates the risk of chronic kidney disease in a diabetic population using proton pump inhibitors in Taiwan. MethodsThis study is based on a specific diabetic database obtained from the National Health Insurance Research Database. Individuals with a new diagnosis of diabetes from 2002 to 2013 were enrolled. “Exposure” to proton pump inhibitors was defined as at least one prescription and dosage over 180 DDD (defined daily dose) in one year after the index date. A multivariable Cox proportional hazard model and competing-risk regression model were applied. ResultsThere were 5994 patients in the final cohort of proton pump inhibitor users and 23,976 patients in the matched controlled cohort based on 1:4 propensity score matching. Compared with no exposure users, PPIs exposure group had more anemia prevalence, anti-hypertension medication and NSAIDs prescriptions.The multivariable Cox proportional hazard model showed that the adjusted hazard ratio of chronic kidney disease was 1.52 (95% CI 1.40–1.65) in diabetic individuals with PPIs exposure, compared with no exposure users. ConclusionsProton pump inhibitors use is associated with 1.52-fold increased risk of chronic kidney disease in diabetic patients when the dosage is over 180 DDD in one year in Taiwan.

Diabetic hip arthropathy is associated with a higher prevalence of femoral head chondromalacia: a case-controlled study.

No previous studies have characterised hip joint disease in diabetic patients undergoing hip arthroscopy. The purpose of our study was to evaluate intra-articular hip pathology and surgical variables in patients with diabetes compared to matched, non-diabetic controls. We hypothesised that diabetic patients would demonstrate a higher prevalence and severity of hip chondral pathology. We retrospectively reviewed 795 consecutive hip arthroscopies performed by a single surgeon between 2010 and 2015. Patients ⩾18 years of age without a history of diabetes served as controls and were matched based on age, sex, body mass index, duration of symptoms, and operative side. Clinical symptoms, preoperative physical examination, and radiologic and intraoperative findings were assessed. The primary outcomes were the acetabular and femoral head chondromalacia index (CMI), calculated as the product of the Outerbridge chondromalacia grade and surface area (mm2*severity). 15 diabetic patients were matched to 137 non-diabetic controls. Diabetic patients demonstrated a higher prevalence of femoral head chondromalacia compared to controls both on magnetic resonance imaging (45.5% vs. 7.5%, p = 0.002) and during arthroscopy (100% vs. 75.9%, p = 0.042). Femoral head chondromalacia in diabetic patients had higher Outerbridge grade (2.4 vs. 2.0, p = 0.030) but similar CMI (513.0 vs. 416.4, p = 0.298) compared to controls. Femoral head chondral pathology was more prevalent and of higher severity grade in diabetic patients. The prevalence, size, and severity of acetabular chondral disease were similar between diabetic and non-diabetic patients. Multivariate analysis demonstrated that diabetic status was independently associated with the presence of femoral head chondromalacia.

The effect of low-level laser irradiation on hyperglycemia-induced inflammation in human gingival fibroblasts.

Hyperglycemia-induced inflammation can greatly increase the risk of periodontal disease in people with diabetes. Low-level laser irradiation (LLLI) has been used for wound healing and anti-inflammation in many cases, and LLLI is known to inhibit the lipopolysaccharide (LPS)-stimulated inflammatory response. However, the therapeutic effect of LLLI in diabetes patients with periodontitis remains unknown. In this study, we cultured human gingival fibroblasts (HGFs) in high-glucose medium (35mM) to mimic a hyperglycemic environment, and then measured the anti-inflammatory effect of LLLI by assessing the expression of pro-inflammatory genes including tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, and IL-8 by quantitative real-time polymerase chain reaction. The results demonstrated no significant inflammatory response in HGFs cultured in mannitol medium and in those treated only with LLLI. However, HGFs cultured only in high-glucose medium showed significantly higher expression of pro-inflammatory cytokine than in those treated together with LLLI. We then observed that LLLI reduced the expression of pro-inflammatory cytokines in HGFs cultured in high-glucose medium by modulating cAMP signaling. We also investigated whether antioxidant (vitamin C) treatment reduced the inflammatory effect of oxidative stress in HGFs cultured in high-glucose medium but found no additive effect upon co-treatment with LLLI, suggesting that LLLI may activate cAMP signaling, but not reactive oxygen species (ROS) signaling, to reduce the high glucose-induced inflammation. In conclusion, LLLI may have an anti-inflammatory effect on HGFs in a high glucose environment and may benefit the treatment of periodontal disease in diabetes patients.

The investigation of protective effects of glucagon-like peptide-1 (GLP-1) analogue exenatide against glucose and fructose-induced neurotoxicity

Diabetes mellitus (DM) is one of the most common metabolic disorders characterized by hyperglycemia due to insufficiency of insulin and/or insulin resistance. Clinical studies have revealed a higher risk of neurodegenerative disorders such as Alzheimer’s disease or Parkinson’s disease in diabetic patients. Recently, glucagon-like peptide-1 (GLP-1) is an attractive potential treatment modality for various neurodegenerative diseases. In our study, we aimed to investigate whether exenatide, a GLP-1 analogue, has neuroprotective effects against glucose and fructose-induced toxicity in human SH-SY5Y neuroblastoma cell line. Neurotoxicity was induced by incubating SH-SY5Y cells with different doses (25–100 mM) of glucose and fructose for 24, 48 and 72 hours. Following determination of the significant toxic doses of glucose and fructose, the cells were treated with various doses of exenatide (10–250 nM) in the presence or absence of glucose and fructose. Neurotoxicity was evaluated by MTT assay and Hoechst 33258 staining. Caspase-3 activity and the levels of advanced glycation end products (AGEs) were determined in the cytosolic fractions of treated cells. Our results demonstrated that both glucose and fructose treatments decreased cell viability in neuronal cells dose and time-dependently. Glucose and fructose-treated groups showed increased numbers of apoptotic cells, caspase-3 activity and AGEs levels. Treatment of the cells with exenatide significantly prevented cell death. The most prominent effect was observed at 100 nM exenatide-treated cultures. Our results suggest that high doses of glucose and fructose may lead to neurotoxicity, and exenatide may have protective effects against neuronal damage through its anti-apoptotic feature.

The prevalence of Peyronie's disease in diabetic patients -2018- Yazd

IntroductionPeyronie's disease (PD) is the fibrous scar tissue inside the penis that causes curved and painful erections. PD is associated with, diabetes, hypertension, dyslipidemia and low testosterone. PD causes erectile dysfunction (ED). The aim of this study was to evaluate the prevalence of PD in type 2 diabetic (T2DM) patients in Yazd. MethodsThis cross-sectional study was conducted on 317 patients with T2DM referred to the Diabetes Research Center of Yazd. Inclusion Criteria were: T2DM, ages 30–65 years old, having a medical record at the Yazd diabetes research center, willingness to participate in research. Exclusin criteria contain: history of smoking and using anti-depressive drugs. Data was analyzed using with SPSS-16 and Stata software. Descriptive tables and charts were used and statistical tests such as independent sample T-test and Fisher's exact test were used. ResultsA total number of 317 male patients were enrolled. The prevalence of diabetes microvascular complications were as following; neuropathy 36.30% (30.97–41.38), retinopathy 24.30% (19.67–29.39), nephropathy 20.50% (16.19–25.37), and PD 3.80% (1.97–6.51). ConclusionThere was no difference in the prevalence of PD in our study with the global studies. But there is a higher prevalence of PD in diabetic patients than the general population.

A general extensible learning approach for multi-disease recommendations in a telehealth environment

In a telehealth environment, intelligent technologies are rapidly evolving toward improving the quality of patients’ lives and providing better clinical decision-making especially those who suffer from chronic diseases and require continuous monitoring and chronic-related medical measurements. A short-term disease risk prediction is a challenging task but is a great importance for teleheath care systems to provide accurate and reliable recommendations to patients. In this work, a general extensible learning approach for multi-disease recommendations is proposed to provide accurate recommendations for patients with chronic diseases in a telehealth environment. This approach generates appropriate recommendations for patients suffering from chronic diseases such as heart failure and diabetes about the need to take a medical test or not on the coming day based on the analysis of their medical data. The statistical features extracted from the sub-bands obtained after a four-level decomposition of the patient’s time series data are classified using a machine learning ensemble model. A combination of three classifiers – Least Squares-Support Vector Machine, Artificial Neural Network, and Naive Bayes – are utilized to construct the bagging-based ensemble model used to produce the final recommendations for patients. Two real-life datasets collected from chronic heart and diabetes disease patients are used for experimentations and evaluation. The experimental results show that the proposed approach yields a very good recommendation accuracy and offers an effective way to reduce the risk of incorrect recommendations as well as reduces the workload for chronic diseases patients who undergo body tests most days. Thus, the proposed approach is considered one of a promising tool for analyzing time series medical data of multi diseases and providing accurate and reliable recommendations to patients suffering from different types of chronic diseases.

Ameliorative Effects of Helianthus Annuus Against Nephrotoxic, Cardiac, and Haematological Disorders in Alloxan-induced Hyperglycaemia in Albino Rats.

IntroductionThe study evaluated the ameliorative effects of Helianthus annuus leaf extract on nephrotoxicity, cardiac, and haematologic disorders in alloxan-induced hyperglycaemic rats.Material and MethodsThe cold maceration method with 80% methanol was used in the preparation of H. annuus extract. Thirty alloxan-induced hyperglycaemic rats were randomly assigned to five equal groups (A–E). Groups A and B received 5% tween-20 solution in water (5 mL/kg) and glibenclamide (2 mg/kg), respectively; while groups C, D, and E received 150, 300, and 600 mg/kg of the extract, respectively, per os once daily for 21 consecutive days. The levels of serum urea, creatinine, haematological indices, and histopathological changes in the kidneys and heart were evaluated 24 h after the last treatment on day 21.ResultsThe extract and glibenclamide significantly (P < 0.05) reduced the levels of serum urea and urea : creatinine ratio in diabetic rats when compared with the vehicle treated group. The extract and glibenclamide also ameliorated haematological disorders and kidney and cardiac damage induced by alloxan.ConclusionH. annuus extract produced nephroprotective, cardioprotective, and haematoprotective effects and might prevent the advancement of diabetic complications such as diabetic nephropathy and cardiovascular diseases in diabetic patients.

Association of carotid intima-media thickness with exercise tolerance test in type 2 diabetic patients

AimsAtherosclerosis and ischemic heart disease are more common in diabetic patients. Atherosclerosis process can disturb the normal functioning of the vascular endothelium and increase vessel wall thickness. The aim of this study was the comparison of Carotid intima-media thickness (CIMT) with Exercise tolerance test as an alternative way to evaluate cardiac ischemia in diabetic patients. MethodsIn a cross-sectional study, 30 diabetic patients with positive exercise test and 30 diabetic patients with negative exercise test were enrolled. CIMT of the carotid artery in both groups of patients was measured. ResultCIMT in the patients with positive and negative exercise test were 1.04 ± 0.21 mm and 0.61 ± 0.11 mm, respectively (P < 0.001). CIMT in positive exercise test group was positively associated with age and negatively associated with gender, FBS, HDL and LDL cholesterol and in negative exercise group was negatively associated with gender, age, FBS, HDL and LDL cholesterol. ConclusionConsidering observed significant positive association between CIMT with result of exercise tolerance test (ETT) in type 2 diabetic patients, it may possible to use CIMT as an inexpensive and non-invasive method for evaluation of ischemic heart disease in diabetic patients.

The epigenetic landscape in the cardiovascular complications of diabetes.

A growing body of evidence suggests that epigenetic modifications-changes to the genome that do not involve changes in DNA sequence-may significantly derail transcriptional programs implicated in angiogenesis, oxidative stress and inflammation, thus fostering cardiovascular damage in patients with diabetes. Notably, adverse epigenetic signals acquired over the life course can be transmitted to the offspring, and may contribute to early cardiovascular phenotypes in the young generations. Hyperglycaemia and insulin resistance-key hallmarks of diabetes-induce an array of epigenetic modifications (i.e., DNA methylation, histone marks, and non-coding RNAs) which are responsible for a long-lasting impairment of vascular and cardiac function, even after intensive glycemic control. Hence, unveiling the "epigenetic landscape" in patients with diabetes may provide a post-genomic snapshot of global cardiovascular risk, and may furnish the tools to design personalized, epigenetic-based therapies to alleviate the burden of cardiovascular disease in diabetic patients. The present review aims to acquaint the scientific community with the rapidly advancing field of epigenetics and its implications in the cardiovascular complications of diabetes.

Role of Hyperglycemia-Induced Advanced Glycation End Product (AGE) Accumulation in Atherosclerosis

There is a growing body of evidence that cumulative hyperglycemic exposure plays a central role in the development and progression of atherosclerotic cardiovascular disease in diabetic patients. Monosaccharides, such as glucose, fructose, and glyceraldehyde can react non-enzymatically with amino groups of proteins, lipids, nucleic acids to form senescent macromolecules termed advanced glycation end products (AGEs), whose formation and accumulation has been known to progress in diabetic patients, especially in those with a long history of disease. The sustained accumulation of AGEs could contribute to the phenomenon of metabolic memory or legacy effects observed in long-term follow-up clinical studies of diabetic patients. AGE modification alters the structural integrity and function of various types of macromolecules, and interaction of AGEs with a receptor for AGEs (RAGE) has been shown to evoke inflammatory and thrombotic reactions. Therefore, the AGE–RAGE axis is a novel therapeutic target of atherosclerotic cardiovascular disease in diabetic patients. In this paper, we briefly review the pathological role of AGEs and their receptor RAGE system in atherosclerotic cardiovascular disease, including peripheral artery disease and discuss the clinical utility of measuring AGEs in evaluating the severity of atherosclerosis in patients with diabetes.

Shear Wave Velocity results of non-alcoholic fatty liver disease in diabetic patients

Amac: Non-alkolik yagli karaciger hastaligi bulunan Tip II diyabetes mellituslu hastalarda, Shear Wave Elastography (SWV) ile karaciger sertligi derecesini degerlendirmek amaclandi. SWV elastografi degerleri ile hepatik steatoz derecesi, karaciger aminotransferazlari, lipit profili ve vucut kitle indeksi karsilastirildi. Gerec ve Yontemler: Bu vaka-kontrol calismasinda, dahiliye klinigine basvuran non-alkolik yagli karaciger hastaligi olan 110 hasta, (57 erkek, 53 kadin, ortalama yas 50,17) ve kontrol grubunda karaciger hastaligi olmayan 50 saglikli yetiskin (26 erkek, 24 kadin), yas ortalamasi (48,26) calismaya alindi. Her bireyde karaciger parankiminin sag lobundan toplam on olcum icin alindi. Hastalarda hepatik steatozun sonografik derecesi, SWV degerleri ve es zamanli alinan laboratuvar degerleri karsilastirildi. Bulgular: SWV ortalama hiz degeri hasta grubunda 2,26 ± 0,5 m/sn) olarak hesaplandi; Kontrol grubunda 1,71±0,3 m/sn; Grade I steatozu olan hastalarda 2,15±0,6 m/sn; Grade II steatozlu hastalarda 2,25±0,4 m/s, grade III steatozlu hastalarda 2,72±0,4 m/s. SWV degerleri hasta ve kontrol gruplarinda istatistiksel olarak anlamli bir fark oldugunu gostermektedir (p < 0,01). Her uc grade karaciger steatozu ile SWV degerlerinin arasinda, istatistiksel olarak anlamli bir farki yoktu. Sonuc: Akustik radiyasyon forse impuls, kanda trigliserit, aspartat transaminaz ve alanin transaminaz artisiyla birlikte, karacigerdeki (ortalama SWV degerleri 2 ve uzerinde ise) doku sertliginin artisinin tespitinde kullanilabilir.

LncRNA Gm4419 promotes the development of cardiac diseases in type 2 diabetic patients with diabetic nephropathy

Diabetic nephropathy has been proved to be correlated with the occurrence of cardiovascular diseases in diabetic patients. However, the mechanism is unclear. LncRNA Gm4419 has been reported to participate in the development of diabetic nephropathy, while its involvement in cardiac diseases is still unknown. Therefore, our study aimed to investigate the correlation between Gm4419 expression and incidence of coronary heart disease (CHD) and stroke. A total of 100 type 2 diabetic patients combined with diabetic nephropathy and 100 type 2 diabetic patients without diabetic nephropathy were included and followed up for 5 years. Renal function and cardiac function indicators as well as serum levels of GM4419 were measured on the day of admission and at the end of follow-up. Occurrence of CHD and stroke was recorded during follow-up and compared between two groups. Renal function of type 2 diabetic patients combined with diabetic nephropathy was worse than that of type 2 diabetic patients without diabetic nephropathy, while no significant differences in cardiac function indicators were found between two groups. Incidences of CHD and stroke were significantly higher in type 2 diabetic patients with diabetic nephropathy than in patients without nephropathy. High serum level of Gm4419 was closely correlated with the occurrence of CHD and stroke as well as poor renal and cardiac functions. LncRNA Gm4419 can promote the development of cardiac diseases in type 2 diabetic patients with diabetic nephropathy.

Association of treatment-achieved HbA1c with incidence of coronary artery disease and severe eye disease in diabetes patients

AimTo examine the association between treatment-achieved HbA1c values and incidence of both coronary artery disease (CAD) and severe eye disease with different diabetes treatments. MethodsAssociations of treatment-achieved HbA1c were investigated in various treatment groups [diet only; insulin; sulphonylurea (SU) alone; SU with glinides; and antihyperglycaemic agents other than glinides, SU or insulin] taken from a nationwide claims database of 14,633 Japanese diabetes patients. Cox’s regression analysis examined risks over a 5.1-year follow-up. ResultsA significant linear trend was associated with HbA1c levels and CAD events in the diet-only group, and CAD risks were significantly higher in insulin and SU groups with HbA1c ≤ 7.0% and > 8.0% than in the diet-only group with HbA1c ≤ 7.0%. In contrast to CAD, a linear association was observed regardless of treatment modality between achieved HbA1c levels and risk of severe diabetic eye disease, but with no significant difference in eye disease risk between groups with HbA1c ≤ 7.0% and 7.1–8.0% in those treated with either SU alone, SU with glinides, or insulin. ConclusionThese findings suggest that the relationship between treatment-achieved HbA1c and incidence of both CAD and severe diabetic eye disease differed according to treatment, based on a large-scale real-life database. More research is now needed to confirm these findings and to further investigate the underlying mechanisms.

Update on renal disease in diabetic patients in primary care

David Morris details complications in the kidneys that diabetes can cause

Peripheral blood mitochondrial DNA copy number is a potential biomarker for progress of diabetic nephropathy in type 2 diabetes patients

Mitochondrial DNA (mtDNA) copy number is a surrogate measure of mitochondrial function, and altered mtDNA copy number has been associated with diabetic nephropathy (DN), a leading cause end stage renal disease in diabetic patients. We investigated whether mtDNA copy number in peripheral blood could be utilized as a biomarker for DN progress in type 2 diabetes (T2D) patients. A total of 50 non-diabetic and 100 diabetic subjects were recruited. The diabetic subjects were sub-divided based on urinary albumin-creatinine ratio (ACR) into T2D patients with normoalbuminuria (ACR < 30 mg/g, n = 50), DN patients with microalbuminuria (ACR 30–300 mg/g, n = 29), and DN patients with macroalbuminuria (ACR > 300 mg/g, n = 21). The mtDNA copy number was measured as relative quantity of mtDNA compared to nuclear DNA using real-time PCR. Overall, the mtDNA copy number was lower in T2D and DN patients than in controls (P < 0.001). Sub-group analyses by ACR showed that lower mtDNA copy number was significantly associated with high levels of albuminuria even after adjusting for conventional risk factors (odds ratio [OR] 0.47, confidence interval [CI] 0.299–0.74 for microalbuminuria and OR 0.21, 95% CI 0.1–0.436 for macroalbuminuria). Moreover, mtDNA copy number was correlated negatively with albuminuria (r = −0.546) and positively with glomerular filtration rate (r = 0.572). The areas under the receiver operating characteristic curves (AUCs) of mtDNA copy number in discriminating DN patients from T2D patients and healthy controls were 0.80 (P < 0.001) and 0.885 (P < 0.001), respectively. Our results showed that peripheral blood mtDNA copy number was associated with the development of DN and could serve as a biomarker during DN progression.

Screening of the lower extremity occlusive arterial disease by the systolic pressure index

Aim: The Lower Extremity Occlusive Arterial Disease (LEOAD) in diabetics is a common complication, too often under diagnosed or neglected. The present study aims to detect arterial disease in diabetic patients by the Systolic Pressure Index (SPI).

Prediction of Heart Disease in Diabetic patients using Naive Bayes Classification Technique

Prediction of Heart Disease in Diabetic patients using Naive Bayes Classification Technique

Rhinocerebral mucormycosis, risk factors and the type of oral manifestations in patients referred to a University Hospital in Tabriz, Iran 2007-2017.

Inadequate data are available on the global epidemiology of mucormycosis, mainly derived from the evaluation of specific population groups. Rhinocerebral mucormycosis is an invading and fatal mycosis, particularly among diabetic patients. In the present study, patients hospitalised in Imam Reza Hospital in Tabriz, from 2007 to 2017, were evaluated. The hospital information system (HIS) was used to collect the records of the patients. A total of 42 patients with a diagnosis of mucormycosis were included in the study, 40 cases (95%) of which had a diagnosis of the rhinocerebral form. Of these 40 patients, 21 (52.5%) and 19 (47.5%) were male and female, respectively. Seven cases (17.5%) of rhinocerebral mucormycosis were due to dental procedures. The most predisposing factor in the patients was diabetes with 36 (90%) cases. In our study, the role of tooth extraction in patients with uncontrolled diabetes was identified as an important factor. It may show the important role of dentists in preventing of the disease in diabetic patients.

Comparative study between Doppler ultrasound and computed tomography angiography in diabetic lower limb arterial insufficiency

Objective This work aimed to highlight the role of color Doppler ultrasound in the assessment of lower limb arterial insufficiency in patients with diabetes as well as the characteristics of lower limb arterial disease in diabetic patients. Background Diabetic lower limb arterial insufficiency is a major health problem affecting the individuals and community health. Doppler ultrasound is a widespread relatively cheap examination with no health hazards of radiation. Hence, we considered studying the role of Doppler ultrasound in determining the characteristics of lower limb arterial diabetic insufficiency and its level of accuracy. Patients and methods One hundred diabetic patients with clinically suspected lower limb arterial insufficiency were examined using Doppler ultrasound and computed tomography angiography (CTA), and the characteristics of diabetic lower limb arterial disease and accuracy of Doppler results in relation to CTA were determined. Results Diabetic lower limb arterial disease was characterized by being bilateral and multisegmental in the majority of cases with more affection of the distal (below knee) arteries. There was no significant difference between Doppler and CTA results at the above knee arteries as regards detection of significant arterial stenosis (luminal narrowing ≥ 50% of artery diameter); P values were as follows: common iliac artery segment, 0.695; external iliac artery, 0.776; common femoral artery, 0.563; and superficial femoral artery, 0.599. Further, a low significant difference at below knee arteries was found; P values were as follows: popliteal artery segment, 0.033; anterior tibial artery, 0.025; posterior tibial artery, 0.019; and peroneal artery, 0.031. The overall sensitivity of Doppler in evaluating lower limb arteries was 90.46%, the specificity was 92.05%, and the accuracy was 91.81% when CTA was taken as a standard. Conclusion Duplex ultrasound provides high-resolution, precise anatomical and physiological information of the peripheral arteries. It should be first-line investigation for lower limb arterial assessment and also be combined with other arterial imaging modalities to obtain better diagnostic accuracy.

Assessment of Endovascular Treatment of Tibial Artery Occlusion in Diabetic Patients

Background: Globally, over 170 million people have diagnosed DM, and by the year 2030, the prevalence is estimated to raise 2.5-fold. Diabetes mellitus (DM) is one of the strongest predictors of peripheral arterial occlusive disease and a significant risk factor for progression of asymptomatic disease or claudication into critical limb ischaemia (CLI). Critical limb ischaemia is the most advanced stage of peripheral arterial occlusive disease. The prognosis is poor, with amputation rates up to been 30% and mortality up to 25 % after 1 year. Aim of the Work: The aim of this work is to evaluate the role of endovascular treatment of tibial artery occlusive disease in diabetic patients, as regard to efficacy, safety, as well as complications. Patients and Methods: This is prospective cohort study, diabetic patients with peripheral arterial occlusive disease (affecting tibial arteries), it is the study of 20 patients, Al-Azhar University Hospitals. Patients with Critical limb ischaemia (CLI) with Computerized Topographic Angiography (CTA) evidence of significant isolated tibial artery occlusive disease (anterior or posterior or both). Patients with generally adequate state of cardiac, respiratory and renal conditions that allow the procedure. Results: The present study was conducted on 20 diabetic patients, 11 males (55%) and 9 females (45%). Their age ranged between 50 years and 87 years with a mean age of 66.7  12.35. All 20 diabetic patients had tibial disease which ranges from segmental stenosis to total occlusion. The procedure time was estimated from the time of infiltration of local anaesthesia to the end of the procedure; It ranged from 45 min to 120 minutes with mean ± SD (88.920. min).The hospital stay ranged from 1 to 21 days with mean ± SD (5.5 ±6.8). Conclusion: Tibial angioplasty demonstrated its feasibility, safety and effectiveness in the treatment of diabetic patients with CLI. Limb salvage should be the main goal in patients with CLI due to infrapopliteal occlusive disease. With a prompt diagnosis, treatment can be started early and serious consequences may be avoided. Revascularisation that can prevent amputation is the ultimate treatment strategy.