Foot Ulceration In Type Research Articles

The Association Between Vitamin B12 Deficiency and Diabetic Foot Ulcer in Type 2 Diabetic Patients in Qassim Province, Saudi Arabia: A Case-Control Study.

Background Diabetic foot ulcer (DFU) is a major complication of diabetes with many identified risk factors. These include poor control of diabetes, cardiovascular disease, smoking, and end-stage kidney disease. This study aims to shed light on the micronutrient status of diabetic patients and its effect on DFU, particularly, the association between vitamin B12 deficiency and DFU. Methodology This retrospective case-control study included adults in Buraydah who were at least 18 years old and had type 2 diabetes mellitus. Data were obtained from the electronic files of the patients who visited the diabetes center from January 2018 to August 2023 and were analyzed using SPSS version 27.0.1 (IBM Corp., Armonk, NY, USA). Results The research involved 221 participants, with 114 controls (individuals with diabetes but no DFU), and 107 cases (individuals with diabetes affected by DFU). Vitamin B12 levels varied, with 79.2% falling within the normal range of 187-883 pg/mL. The average age of cases (58.5 years, SD = 11.3) was notably higher than that of controls (54.1 years, SD = 14.1).Glycated hemoglobin levels were significantly higher in cases (8.7, SD = 2.0) compared to controls (7.6, SD = 2.2) (p < 0.001). Regarding physical activity, cases showed a significantly higher percentage of inactivity (62.1%) compared to controls (39.1%) (p = 0.046). Neuropathy exhibited a significant association with ulcer development, with 59.1% of cases having neuropathy compared to 23.5% of controls (p < 0.001). Furthermore, complications such as dry foot and fissures (60.0% vs. 6.3%), Charcot joint (36.8% vs. 12.2%), and foot trauma (40.9% vs. 3.9%) were significantly more prevalent in cases compared to controls (p < 0.001 for all). Conclusions The significant associations observed with advanced age, uncontrolled diabetes, longer diabetes duration, neuropathy, and specific foot complications underscore the multifactorial nature of ulcer development. The normal levels of vitamin B12 in most patients reflect no positive impact of normalized vitamin B12 levels on DFU. However, further observational studies with multiple vitamin B12 readings over a longer period are needed to establish its association with DFU development.

Topical Application of Autologous Plasma-Derived Plasminogen Accelerates Healing of Chronic Foot Ulcers in Type 2 Diabetes Patients.

Plasminogen (Pg) is currently considered a master regulator of wound healing, but the molecular mechanisms of its efficacy in improving impaired closure of chronic skin ulcers in type 2 diabetes patients remain unclear. Here, we investigated wound healing effects of autologous plasma-derived Pg in diabetes patients with chronic foot ulcers and evaluated Pg-induced changes in levels of key protein markers related to wound repair. Type 2 diabetes patients with chronic wounds of lower extremities were included in the study and received topical applications of Pg in a dose of 1.0 mg/mL every 2 days during 20 days, in addition to the standard wound management treatment. Patients treated only according to conventional protocol served as a control. Wound closure rates were monitored by digital planimetry of wound areas. Plasminogen supplementary treatment significantly accelerated relative wound closure as compared with diabetes patients from the control group (24 ± 4 days vs 120 ± 17 days, respectively, P < .01). As shown by Western blot, Pg application reduced expression of protein regulators of hypoxia events, angiogenesis, and autophagy such as hypoxia-inducible factor-1α (by 6.3-folds, P < .01), angiostatins (by 2.5-folds, P < .05), and autophagy marker LC3-II/LC3-I (by 8.6-folds, P < .05), while increasing vascular endothelial growth factor level by 1.9-folds (P < .05). Gelatin zymography showed that Pg-supplemented therapy decreased activity of matrix metalloproteinase-9 (MMP-9) by 3.5-folds at the end of treatment period (P < .01). We report here for the first time that topically applied plasma-derived Pg has a pronounced beneficial effect in promoting foot ulcer healing in patients with type 2 diabetes through preventing hypoxia-induced signaling, reducing autophagy flux, diminishing excessive MMP activity, and enhancing angiogenesis.

The skin autofluorescence of advanced glycation end-products relates to the development of foot ulcers in type 2 diabetes: A longitudinal observational study

ObjectivesThe long-term glycemic memory contributes to vascular complications in type 2 diabetes, including those patients with Diabetic Foot Ulcers (DFU). We investigated whether the skin autofluorescence (SAF) of Advanced Glycation End-products related to later DFUs. Research design & methodsSAF was measured with an AGE-Reader in a retrospective cohort of patients hospitalized from 2009 to 2017 for Type 2 Diabetes. New DFUs were registered until the year 2020 and survival analyses were performed. ResultsThe 517 patients (men: 58.0 %), were 62 ± 9 years old at baseline, with a duration of diabetes of 14 ± 10 years, HbA1c: 8.7 ± 1.8 %, complications included 33.8 % macroangiopathies, 44.9 % diabetic kidney diseases and 26.7 % retinopathies. According to the IWGDF classification, the grades of risk for DFU were 0 for 43.2 %, 1 for 23.9 %, 2 for 7.2 %, and 3 for 25.7 %. During the 53 months of follow-up, 58 new DFUs occurred, mostly in patients with SAF higher than its median value (2.65 AU). Adjusted for age and sex, conventional risk factors (duration and control of diabetes, arterial hypertension, dyslipidemia, smoking), and other complications (macroangiopathy, diabetic kidney disease, retinopathy), SAF related to later DFUs. Adjusted for the IWGDF classification, SAF related to new DFUs (HR: 1.81, 95%CI:1.25–2.62). This relationship was significant for the 403 subjects without previous history of DFU (HR: 2.32, 95%CI: 1.36–3.95). SAF did not predict recurrence for patients with a previous history of DFUs. ConclusionSAF, a simple non-invasive marker of glycemic memory, independently predicts the occurrence of a first foot ulcer in patients with Type 2 Diabetes.

WITHDRAWN: Recognition and Anticipation of Diabetic Foot Ulcer in Type II Diabetic patients using Multi-layered Fuzzy Model

WITHDRAWN: Recognition and Anticipation of Diabetic Foot Ulcer in Type II Diabetic patients using Multi-layered Fuzzy Model

Prevalence and Factors Associated with the Stratified Risk to Develop Diabetic Foot Ulcer in Type 2 Diabetes Mellitus Patients in Primary Care Unit of Songklanagarind Hospital

Objective: To determine the prevalence of and to assess factors associated with diabetic foot in type 2 diabetes mellitus (DM) patients in the primary care unit (PCU) of Songklanagarind Hospital. Materials and Methods: The present study was a cross-sectional study that collected the data of 160 type 2 DM patients attending the PCU of Songklanagarind Hospital between March and July 2020 using a questionnaire and face-to-face interviews. The classification of diabetic foot severity was based on foot examination using the 2017 Guideline of the Diabetes Association of Thailand. Results: There were 160 participants in the present study, 44.4% were male and 55.6% were female. There were 58.1% aged less than 60 years and 41.9% aged more than or equal to 60 years. The diabetic patients who had foot ulcer were not found in the present study. There were 31.2%, 63.1%, and 5.6% of the patients had low, medium, and high risk of diabetic foot, respectively. In multivariate analysis, the adjusted odds ratios (ORs) with 95% confidence intervals (CI) found the factors associated with positively increased diabetic foot risk were some occupations including self-employed 5.19 (1.53 to 18.91) and agriculturist 4.82 (1.38 to 18.44), chronic kidney disease (CKD) 18.17 (2.46 to 131.32), longer duration of DM 3.14 (1.40 to 7.40), diabetic retinopathy (DR) 11.90 (3.44 to 50.00). Some factors negatively increased the risk were low-density lipoprotein (LDL) less than 100 mh/dL 0.37 (0.16 to 0.81), self-care behavior including asking others to check blind areas of the foot 0.21 (0.07 to 0.63), and foot exercise 0.29 (0.12 to 0.68) (p&lt;0.05). Conclusion: Diabetic foot in type 2 DM patients at the PCU of Songklanagarind Hospital was not found. However, it is important to establish PCU to identify feet at risk included occupations, CKD, longer duration of DM, LDL more than 100 mh/dL, DR, and lack of self-care practices for primary and secondary prevention in DM patients. Keywords: Diabetes mellitus; Diabetic foot; Primary care

Application of antibiotic bone cement in the treatment of infected diabetic foot ulcers in type 2 diabetes

BackgroundIn this study, we try to investigate the effect of antibiotic bone cement in patients with infected diabetic foot ulcer (DFU).MethodsThis is a retrospective study, including fifty-two patients with infected DFU who had undergone treated between June 2019 and May 2021. Patients were divided into Polymethylmethacrylate (PMMA) group and control group. 22 patients in PMMA group received antibiotic bone cement and regular wound debridement, and 30 patients in control group received regular wound debridement. Clinical outcomes include the rate of wound healing, duration of healing, duration of wound preparation, rate of amputation, and frequency of debridement procedures.ResultsIn PMMA group, twenty-two patients (100%) had complete wound healing. In control group, twenty-eight patients (93.3%) had wound healing. Compared with control group, PMMA group had fewer frequencies of debridement procedures and shorter duration of wound healing (35.32 ± 3.77 days vs 44.37 ± 7.44 days, P < 0.001). PMMA group had five minor amputation, while control group had eight minor amputation and two major amputation. Regarding the rate of limb salvage, there was no limb lose in PMMA group and two limb losses in control group.ConclusionThe application of antibiotic bone cement is an effective solution for infected DFU treatment. It can effectively decreased the frequency of debridement procedures and shorten the healing duration in patients with infected DFU.

Development and validation of a risk prediction model for the recurrence of foot ulcer in type 2 diabetes in China: A longitudinal cohort study based on a systematic review and meta-analysis.

To develop and validate a risk prediction model for Chinese patients with type 2 diabetes with the recurrence of diabetic foot ulcers (DFUs) based on a systematic review and meta-analysis. A prospective analysis was performed with 1333 participants and followed up for 60months. Three models were analysed using a derived cohort. The risk factors were screened using meta-analysis and logistic regression, and the missing variables were interpolated by multiple imputation. The internal validation was performed using the bootstrap procedure, and the validation cohort was applied to the external validation. The performance of the model was evaluated in the area under the discrimination Receiver Operating Characteristic Curve (ROC). Calibration and discrimination methods were used for the validation cohort. The variables were selected according to their clinical and statistical importance to construct the nomograms. Three models were developed and validated. Model 1 included seven social and clinical indicators like sex, diabetes mellitus duration, previous DFU, location of ulcer, smoking, history of amputation, and foot deformity. Model 2 included four more indicators besides those in Model 1, which were statin agents used, antiplatelet agents used, systolic blood pressure, and body mass index. Model 3 added further laboratory indicators to Model 2, such as LDL-C, HbA1C, fibrinogen, and blood urea nitrogen. In the derivation cohort, 20.1% (206/1027) participants with DFU recurred as compared to the validation cohort, which was 38.2% (117/306). The areas under the curve in the derivation cohort for Models 1-3 were 0.781 (0.744-0.817), 0.843 (0.813-0.873), and 0.899 (0.876-0.922), respectively. The Youden indexes for Models 1-3 were 0.430, 0.559, and 0.653, respectively. Model 3 showed the highest sensitivity and specificity. All models performed well for both discrimination and calibration. Models 1-2 were non-invasive, which indicate their role in general screening for patients at a high risk of recurrence of DFU. However, Model 3 offers a more specific screening due to its best performance in predicting the risk of DFU recurrence amongst the three models.

Albuminuric diabetic kidney disease predicts foot ulcers in type 2 diabetes

Diabetic Foot Ulcers (DFU) are feared among individuals with diabetic kidney disease (DKD), but it is unclear whether they are more frequent, especially in normoalbuminuric DKD.Five hundred and twenty patients admitted in our diabetology ward from 2007 to 2017 were followed up during 54 ± 26 months. New DFUs were registered, and their relationship with the initial renal status was analyzed by LogRank and multivariate Cox regression analysis.The 520 subjects were mainly men (57.9 %), 62 ± 9 years old, with a duration of diabetes of 14 ± 10 years, HbA1c: 8.7 ± 1.8 % (72 ± 19 mmol/mol), and complications: 33.7 % macroangiopathies, 22.1 % previous foot ulcers, 44.8 % DKD, 26.9 % retinopathies. Fifty-seven new DFU occurred, mainly in subjects with DKD. DKD was related to later DFU (HR: 1.79; 95%CI: 1.05–3.07), this relationship stayed significant adjusted for age, gender, and a history of previous DFU (HR: 3.61; 95%CI: 2.11–6.18), and further adjusted for the duration of diabetes, HbA1c, BMI, arterial hypertension, and dyslipidemia. Among the 233 subjects with DKD, 129 (55.3 %) had an isolated AER > 30 mg/24H, 41 (17.6 %) had an isolated eGFR<60 mL/min/1.73 m2, and 63 (27.0 %) cumulated both abnormalities. By Cox regression analysis adjusted for age and gender, albuminuric DKDs were related to later DFU: with eGFR≥60: HR: 1.91; 95%CI: 1.02–3.59, with eGFR<60: HR: 2.53; 95%CI: 1.25–5.10, whereas normoalbuminuric DKD was not: HR: 1.04; 95%CI: 0.35–3.07, despite similar rates of neuropathies, peripheral arterial diseases, and retinopathies.In people with type 2 diabetes, albuminuric DKD was associated with two to three folds increased risk of DFUs, whereas normoalbuminuric DKD was not.

Risk Factors of Diabetic Foot Ulcers in Type 2 Diabetes Mellitus Patients: Basis for Foot Care Education

the seventh largest number of diabetic patientsand diabetes is also the third cause of death after stroke andhypertension.Diabetic Foot Ulcers (DFU) are common cause of diabetes mellitus complications.Foot problemsoften receive less attention and it is not the priority for many health professionals in Indonesia. Diabetic foot ulcersare preventable through Diabetes Foot Care Education.Aim:The study aimed to assess risk factors of Diabetic Foot Ulcers in patients with Type 2 Diabetes Mellitus anddevelop an appropriate diabetic foot care education.Methodology: This study used prospective research design and conducted atWocare Diabetic Clinic in BogorIndonesia.Study populations will be all Type 2 Diabetes Mellitus patients with a total sample of 48patients. Ordinaland nominal data were described by absolute values and percentage while continuous data was reported as meanand standard deviation. Univariate data was analyzed by χ2 test or Fisher exact test for categorical and Wilcoxontest for continuous data. The significance level will be set at 95% with p-value=0.05.Result:There was an increase in the average diabetic foot care behavior before and after education with a meanvalue of 79.6 to 79.9.The results of the Wilcoxon test showed a p-value of 0.000.Conclusion:There was a significant difference between behavioral scores before and after intervention with footcare education.

Association between triglyceride glucose index and severity of diabetic foot ulcers in type 2 diabetes mellitus

BackgroundTriglyceride glucose (TyG) index is a good surrogate biomarker to evaluate insulin resistance (IR). The study aimed to investigate whether the TyG index is related to the severity of diabetic foot ulcers (DFUs) in patients with type 2 diabetes mellitus (T2DM).MethodsA total of 1059 T2DM patients were enrolled in this observational, retrospective, single-center study. TyG index was calculated as ln[fasting triglycerides (mg/dl) × fasting glucose (mg/ dl)/2]. The severity of DFUs was classified into mild-to-moderate DFUs (Wagner grade score < 3) and severe DFUs (Wagner grade score ≥ 3) based on Wagner classification. Patients were stratified according to the tertiles of TyG index. Logistic regression models were implemented to explore the association between TyG index and the severity of DFUs. Subgroup analyses were used to verify the reliability of results.ResultsCompared with the reference lowest TyG tertile (T1), the highest tertile (T3) was associated with 0.377-fold increased risk of prevalence of severe DFUs (odds ratio [OR] 1.377, 95% confidence interval [CI] 1.017–1.865) (P = 0.039). After adjusting for potential confounders, the multivariable-adjusted OR and 95% CI were 1.506 (1.079–2.103) (P = 0.016) in patients with highest tertile. Moreover, subgroup analyses indicated that the association was stronger among men, patients with age ≥ 65 years, duration of diabetes more than 10 years, or without PAD.ConclusionsElevated TyG index is independently associated with severity of DFUs even after adjusting conventional confounders.

The Relationship of Obesity to Diabetic Foot Ulcer in Type 2 Diabetes Mellitus Patients

Diabetes mellitus is a group of metabolic diseases, the common finding of which is elevated blood glucose levels, known as hyperglycemia. Severe hyperglycemia causes classic symptoms such as polyuria, polydipsia, and polyphagia and unexplained weight loss. This study used an observational descriptive analytic method with a cross sectional design to 42 respondents of type 2 Diabetes mellitus patients at PKU Muhammadiyah Gamping Hospital. The blood sugar levels, HbA1C, height, weight and incidence of diabetic foot ulcers were recorded. Data analysis used the Chi-Square test to see the relationship between obesity and the incidence of diabetic foot ulcers in patients with type 2 diabetes mellitus. The results of the study on 42 respondents showed that there were 31 Diabetes mellitus patients with diabetic foot ulcers (73.8%) while 11 people (26.2%). There were 21 male patients (50%) and 21 female patients (50%). A total of study subjects with normal Body Mass Index had type 2 diabetes mellitus with complications of diabetic foot ulcers (77.8%.), 13 study subjects with overweight Body Mass Index experienced type 2 diabetes mellitus with complications of diabetic foot ulcers (61.9%.), 11 study subjects with Body Mass Index obese class 1 had type 2 diabetes mellitus with complications of diabetic foot ulcers (91.7%). In patients with type 2 diabetes mellitus without complications of diabetic foot ulcers with normal Body Mass Index, there were 2 people (22.8%.) In patients with type 2 diabetes mellitus without complications of diabetic foot ulcers with Body Mass Index overweight, there were 8 people (38.1%). Then in patients with type 2 diabetes mellitus without complications of diabetic foot ulcers with Body Mass Index obesity class 1 obtained 1 person (8.3%). The Chi-Square test was performed and the p value = 0.166. There is no significant relationship between obesity and the incidence of diabetic foot ulcers in patients with type 2 diabetes mellitus.

Polypharmacy is Associated with Diabetic Foot Ulcers in Type 2 Diabetes mellitus.

Objectives: This observational study aimed to investigate the relationship between polypharmacy and the existence of diabetic foot ulcers in patients with type 2 diabetes. Methods: Patients with T2DM with and without diabetic foot ulcers who presented to the endocrinology outpatient clinic between August 2020 and November 2021 were involved in the study. Overall, five hundred and twelve patients with T2DM (293 patients with diabetic foot ulcer and 219 patients without diabetic foot ulcer) were included. The exclusion criteria were pregnancy, lactation, type 1 diabetes, patients under 18 years and over 65 years of age, and history of malignancy. The information of drugs administered, demographic and clinical data were obtained from the patient files. The Wagner score was used to evaluate the severity of ulcers. Results: The comparison of the two groups revealed that patients with diabetic foot ulcers had significantly higher rates of diabetic retinopathy (p = 0.017). The patients with diabetic foot ulcers who had polypharmacy had significantly higher rates of hypertension, ischaemic heart disease, diabetic retinopathy, and complaints of diabetic neuropathy (P < 0.001, P < 0,001, p = 0.021 and P = 0.004, respectively). In the binary logistic regression analyses, polypharmacy was independently associated with diabetic foot ulcers in all models. Conclusion: Polypharmacy should be seriously concerned in type 2 diabetes mellitus in patients with diabetic foot ulcers and polypharmacy was related to diabetic foot ulcers.

Early detection of foot ulceration in type II diabetic patient using registration method in infrared images and descriptive comparison with deep learning methods

Early detection of foot ulceration in type II diabetic patient using registration method in infrared images and descriptive comparison with deep learning methods

Perbaikan Ulkus Diabetik Dengan Penerapan Latihan Range Of Motion Ekstremitas Bawah Pada Diabetes Tipe 2

Diabetic ulcers are one of the chronic complications of type 2 diabetes due to chronic hyperglycemia resulting in impaired perfusion and neuropathy. Range of motion exercises in lower extremities improve peripheral perfusion with the aim of facilitating the diffusion of oxygen and adequate supply of nutrients to the ulcer area. The research objectives were identified and analyzed for diabetic improvement in the application of lower extremity range of motion exercises. Case study research design, 2 research subjects, at the Wound Clinic Diabetes Center Bandar Lampung for 2 weeks. The results of the study before the lower extremity range of motion of the degree of diabetes of the two respondents scored 2, after the range of motion of the lower extremity of the degree of diabetes both respondents scored 1. The conclusion of this study showed that lower extremity range of motion exercises can improve the repair of diabetic ulcers in type II diabetes patients. Lower extremity range of motion exercise can be one of the independent interventions carried out for the treatment of diabetic foot ulcers in type 2 diabetes.

Enhanced Expression of miR-34c in Peripheral Plasma Associated with Diabetic Foot Ulcer in Type 2 Diabetes Patients.

ObjectiveTo explore the correlation between the expression of miR-34c in peripheral blood of patients with type 2 diabetes mellitus (T2DM) and the onset of diabetic foot ulcer (DFU) and diabetic foot osteomyelitis (DFO).MethodsSixty newly diagnosed patients with T2DM without DFU (T2DM group), 112 T2DM patients with DFU (DFU group) and 60 controls with normal glucose tolerance (NC group). The DFU group patients were subdivided into DFO (n=64) and NDFO (n=48) groups. Quantitative real-time PCR (qRT-PCR) method was used to determine miR-34c expression levels in the peripheral blood of subjects to analyze the clinical characteristics of DFU and DFO risk factors.ResultsMiR-34c expression level in the T2DM group was marked higher than the NC group [2.99 (1.45–6.22) vs 1.01 (0.89–1.52)] (P < 0.05). However, the expression level of miR-34c in the DFU group was significantly higher than the T2DM group [9.65 (6.15–18.63) vs 2.99 (1.45–6.22)] (P < 0.01). Compared with the NDFO group, the expression level of miR-34c in the DFO group was also obviously increased [13.46 (8.89–19.11) vs 6.02 (5.93–14.72)] (P < 0.01). The expression level of miR-34c in DFU patients was positively correlated with the amputation rate of foot ulcers (P=0.030) and was negatively correlated with the healing rate of foot ulcers after eight weeks (P=0.025). Multifactorial logistic regression analysis showed that increased expression of miR-34c was an independent risk factor for DFU and DFO (ORDFU=3.47, ORDFO=4.25, P < 0.01). Meanwhile, the ROC curve analysis indicated that the AUC of miR-34c for the diagnosis of DFU and DFO was 0.803 and 0.904, the optimum sensitivity being was 100% and 98.7%, the optimum specificity was 98.4% and 98.4%, respectively.ConclusionThe increased expression of miR-34c in peripheral blood of T2DM patients is closely related to the occurrence, development and prognosis of DFU and DFO.

The Influence of Deformity and Limited Joint Mobility on Foot Ulceration in Type 2 Diabetes

The Influence of Deformity and Limited Joint Mobility on Foot Ulceration in Type 2 Diabetes

Incidence and characteristics of diabetic foot ulcers in subjects with type 2 diabetes in Catalonian primary care centres: An observational multicentre study

AimsThe main objective was to assess the incidence of diabetic foot ulcers in type 2 diabetes individuals from primary care centres in Catalonia, Spain. MethodsProspective observational study in 36 Primary Care centres in Catalonia during February 2018 and July 2019 was conducted. We included participants with type 2 diabetes and a new foot ulcer. We estimated the annual foot ulcer incidence and described the characteristics: presence of comorbidities, clinical parameters and the characteristics of the diabetic foot ulcers (DFU) at inclusion in the study. ResultsThe incidence of a new DFU during the 12-month recruitment period was 0.42%. The mean age of the participants was 72.2 years (± 12.7), the majority of them were males (n = 178; 69.5%). Overall, 43.8% of DFUs were located on the dorsal aspect of toes or interdigital spaces. A percentage of 43.4% of the participants had ulcers of less than 1 cm2 surface. Further, 44.1% of the participants had a neuroischemic, 20.3% a neuropathic, 20.3% an ischemic ulcer. A 25.3% of ulcers with a concomitant peripheral artery disease were infected. ConclusionsAlthough the incidence found was low, our study shows the great complexity of patients with foot ulcers treated in primary care.

T-Natural Killers and Interferon Gamma/Interleukin 4 in Augmentation of Infection in Foot Ulcer in Type 2 Diabetes.

BackgroundThe link between immune system and type 2 diabetes mellitus (T2DM) pathogenesis attracted attention to demonstrate the role of immune cells and their secreted cytokines in T2DM development and its subsequent foot complications.ObjectiveTo investigate the relation between T Natural killer cell (TNK) %, Interleukin 4 (IL4) and Interferon gamma (IFN-γ) and diabetic foot infection (DFI) development in patients with diabetic foot ulcer (DFU).Patients and MethodsNinety patients with diabetes were included in this work, divided as T2DM group (n=30), DFU group (n=30), and DFI group (n=30). TNK% was detected using flow cytometry. Serum IL4 and IFN-γ were measured by ELISA. Diabetes biochemical parameters were also analyzed.ResultsSignificant decrease was detected in TNK% and IFN-γ in DFI group compared to other 2 groups (P<0.001). Significant decrease was detected in serum levels of IL4 in DFI group compared to T2DM group (P=0.006). IFN-γ/IL4 was significantly decreased in DFI compared to DFU group (P=0.020). There was a significant correlation of TNK% with both IL4 and IFN-γ (r=0.385, P<0.001; r=0.534, P<0.001, respectively). Significant negative correlation of TNK% with HbA1c and LDL was revealed (r=−0.631, P<0.001; and r=−0.261, P=0.013, respectively), while a positive correlation was seen with HDL (r=0.287, P=0.006). A significant negative correlation of IL4 with HbA1c was found (r=−0.514, P<0.001;. As for IFN-γ, a significant negative correlation with HbA1c and LDL was detected (r=−0.369, P< 0.001; r=−0.229, P=0.030). TNK % and IFN-γ level showed negative correlations with disease duration/year (r=−0.546, P< 0.001; r=−0.338, P=0.001,respectively).ConclusionDecline in TNK frequency has essential role in T2DM pathogenesis and subsequent foot complications. Downregulation of TNK% and IFN-γ level have potential roles in predicting infection of diabetic ulcer and are correlated with disease duration.

Temporal Trends in Incident Hospitalization for Diabetes-Related Foot Ulcer in Type 2 Diabetes: The Fremantle Diabetes Study.

To determine whether, reflecting trends in other chronic complications, incident hospitalization for diabetes-related foot ulcer (DFU) has declined over recent decades in type 2 diabetes. Participants with type 2 diabetes from the community-based Fremantle Diabetes Study phases I (FDS1; 1,296 participants, mean age 64.0 years, 48.6% males, recruited 1993-1996) and II (FDS2; 1,509 participants, mean age 65.4 years, 51.8% males, recruited 2008-2011) were followed from entry to first hospitalization for/with DFU, death, or 5 years (whichever came first). Incident rate ratios (IRRs) and incident rate differences (IRDs) were calculated for FDS2 versus FDS1 overall and in 10-year age-groups. Cox proportional hazards modeling determined independent predictors of first DFU hospitalization in the combined cohort. Incident DFU hospitalization (95% CI) was 1.9 (0.9-3.3)/1,000 person-years in FDS1 during 5,879 person-years of follow-up and 4.5 (3.0-6.4)/1,000 person-years in FDS2 during 6,915 person-years of follow-up. The crude IRR (95% CI) was 2.40 (1.17-5.28) (P = 0.013) and IRD 2.6 (0.7-4.5)/1,000 person-years (P = 0.010). The highest IR for any age-group was 23.6/1,000 person-years in FDS2 participants aged 31-40 years. Age at diabetes diagnosis (inverse), HbA1c, insulin use, height, ln(urinary albumin/creatinine), absence of any foot pulse, previous peripheral revascularization, and peripheral sensory neuropathy (PSN) were independent predictors of incident hospitalization for/with DFU. Incident DFU hospitalizations complicating type 2 diabetes increased between FDS phases, especially in younger participants, and were more likely in those with PSN, peripheral arterial disease, and suboptimal glycemic control at baseline.

Effect of pulsed electromagnetic therapy on foot ulcers in type I diabetic adolescents (A Randomized Controlled Trial).

Effect of pulsed electromagnetic therapy on foot ulcers in type I diabetic adolescents (A Randomized Controlled Trial).