Importance of "heart health" in those with diabetic foot ulcers

NewsBot · Nov 10, 2008

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The BBC are reporting:
Diabetes study cuts ulcer deaths

A ground-breaking system which could halve the number of people dying from a diabetes-related condition has been developed in the Lothians.

New research shows patients suffering from a diabetic foot ulcer could win their battle if their heart health was also treated at the same time.

Royal Infirmary of Edinburgh experts discovered a system of heart monitoring combined with preventative medicine.

Dr Matthew Young said the key to their survival was their hearts.

A full cardiovascular assessment was carried out on each patient to gauge their blood pressure, cholesterol and heart function before prescribing a range of protective medicines in a unique tailor-made care package.

Dr Young said: "By applying the principles of cardiovascular risk reduction, and by learning more about a patients' cardiac health, we were able to offer them a more specialised package of care.
"These improvements have halved this death rate to under a quarter of foot ulcer patients dying within five years of their ulcer.

"If this was repeated across Scotland it would prolong the lives of thousands of patients and tens of thousands in the UK as whole."

The team from the Diabetic Foot Clinic at the Royal Infirmary of Edinburgh carried out the research following the introduction of the new cardiovascular policy in 2001.

Foot ulcers are known to be associated with heart disease and the experts realised that the appearance of a foot ulcer pointed to arterial damage elsewhere in the body.

Risk assessment:
They decided to give every patient, being treated after 2001, medicines to actively target heart disease even if they had no history of cardiovascular illness to protect them from future episodes.

Aspirin, statin therapy, ACE inhibitors and beta blockers were prescribed to all patients in the second group of the study.

Researchers then monitored the death rates in foot ulcer patients from both groups and compared their records.

A total of about 400 patients who developed a foot ulcer between 1995 and 1999 and about 250 patients who were diagnosed between 2001 and 2004 were monitored in the study.

The experts discovered that four-year mortality was cut in half by the new policy. In group one the death toll was 43.3%, compared to 21.9% in the second group who received the heart risk assessment and treatment.

Dr Young said the cardiovascular risk management system should be rolled out in clinics across the country.
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NewsBot · Sep 25, 2019

In patients with diabetic foot, improved left ventricular functions are detected by strain echocardiography after the diabetic foot treatment
A cross-sectional study
Demirtas, Derya MD; Kucukosmanoglu, Mehmet MD
Medicine: September 2019 - Volume 98 - Issue 38 - p e17217

Diabetic foot is a macrovascular complication of diabetes mellitus (DM). In the literature, the relationship between diabetic foot and another macrovascular complication of DM is not clear. The aim of this study was to determine the current left ventricular (LV) systolic function in patients with diabetic foot and to investigate the effect of diabetic foot treatment on LV systolic functions.

In this study, 54 patients with diabetic foot and 22 patients without diabetic foot were included. Routine anamnesis, physical examination, echocardiography, and laboratory examinations were performed. In addition, LV global longitudinal strain (LV-GLS) was measured by strain echocardiography technique. LV ejection fraction (LV-EF) and LV-GLS measurements were repeated with echocardiography at the 3rd month of diabetic foot treatment.

The incidence of cardiovascular risk factors such as smoking, hypertension, and coronary artery disease was found to be higher in patients with diabetic foot. (P < .05 for each one). Similarly, in patients with diabetic foot, glucose, Hemoglobin A1c, neutrophil, sedimentation, urea, creatinine, potassium, uric acid, alanine aminotransferase, aspartate aminotransferase, C-reactive protein, and brain natriuretic protein were higher; high-density lipoprotein cholesterol level was found to be significantly lower. LV wall thicknesses and diameters were higher and LV-EF was lower in patients with diabetic foot (P < .05 each one). LV-GLS values were significantly lower in patients with diabetic foot (P < .05). Although no significant change was found in the LV-EF value at the 3rd-month follow-up echocardiography (48.6% ± 7.0% vs 48.5% ± 5.9% and P = .747), it was detected that LV-GLS values (17.3 ± 2.1 vs 18.4 ± 2.3) were significantly increased (P < .001).

LV systolic function was significantly affected in patients with diabetic foot. This may be related to the increased frequency of cardiovascular risk factors in these patients. However, the significant improvement in LV-GLS values after the diabetic foot treatment showed that diabetic foot itself was an important cause of LV systolic dysfunction
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