The 'diabetic foot' and eye complications

NewsBot · Mar 27, 2015

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Diabetic Foot Syndrome and Corneal Subbasal Nerve Plexus Changes in Congolese Patients with Type 2 Diabetes.
Zhivov A et al
PLoS One. 2015 Mar 26;10(3):e0119842

BACKGROUND:
To study the severity of diabetic neuropathy, diabetic retinopathy and grades of diabetic foot syndrome for correlations with corneal subbasal nerve plexus (SBP) changes in Congolese patients with type 2 diabetes.
METHODOLOGY/PRINCIPAL FINDINGS:
Twenty-eight type 2 diabetes patients with diabetes-related foot ulceration were recruited in a diabetic care unit in Kinshasa, Democratic Republic of Congo. Corneal SBP was investigated by confocal laser-scanning microscopy to analyse nerve fibre density (NFD) [µm/ µm²], number of branches [n] and number of connectivity points [n]. Foot ulceration was graded using the Wagner ulcer classification. Corneal sensitivity (Cochet-Bonnet), Neuropathy Symptom Score (NSS), Neuropathy Disability Score (NDS), ankle-brachial index (ABI) and ophthalmological status were evaluated. Foot ulceration was ranked as mild (Wagner 0-1: 13 patients/46.4%), moderate (Wagner 2-3: 10 patients/35.7%) and severe (Wagner 4-5: 5 patients/17.9%). The correlation between Wagner Score and NFD (p=0.017, r = - 0,454), NDS and NFD (p=0,039, r = - 0.400) as well as Wagner Score and HbA1c (p=0,007, r = - 0.477) was stated. Significant differences in confocal SBP parameters were observed between Wagner 0-1 and Wagner 4 5 (number of branches (p=0.012), number of connectivity points (p=0.001), nerve fibre density (p=0.033)) and ABI (p=0.030), and between Wagner 2-3 and Wagner 4-5 (number of branches (p=0.003), number of connectivity points (p=0.005) and nerve fibre density (p=0.014)). Differences in NDS (p=0.001) and corneal sensation (p=0.032) were significant between Wagner 0-1 and Wagner 2-3. Patients with diabetic retinopathy had significantly longer diabetes duration (p=0.03) and higher NDS (p=0.01), but showed no differences in SBP morphology or corneal sensation.
CONCLUSIONS/SIGNIFICANCE:
While confirming the diabetic aetiology of foot ulceration due to medial arterial calcification, this study indicates that the grade of diabetic foot syndrome correlates with corneal SBP changes and corneal sensation in patients in sub-Saharan Africa.
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NewsBot · Apr 8, 2017

Association between diabetic foot ulcer and diabetic retinopathy.
Hwang DJ et al
PLoS One. 2017 Apr 7;12(4):e0175270. doi: 10.1371/journal.pone.0175270. eCollection 2017.

PURPOSE:
We aimed to investigate the prevalence of diabetic retinopathy (DR) in patients with diabetic foot ulcer (DFU) and elucidate the association between DR and DFU severities and their shared risk factors.
METHODS:
A retrospective review was conducted on DFU patients who underwent ophthalmic and vascular examinations within 6 months; 100 type 2 diabetic patients with DFU were included. The medical records of 2496 type 2 diabetic patients without DFU served as control data. DR prevalence and severity were assessed in DFU patients. DFU patients were compared with the control group regarding each clinical variable. Additionally, DFU patients were divided into two groups according to DR severity and compared.
RESULTS:
Out of 100 DFU patients, 90 patients (90%) had DR and 55 (55%) had proliferative DR (PDR). There was no significant association between DR and DFU severities (R = 0.034, p = 0.734). A multivariable analysis comparing type 2 diabetic patients with and without DFUs showed that the presence of DR [OR, 226.12; 95% confidence interval (CI), 58.07-880.49; p < 0.001] and proliferative DR [OR, 306.27; 95% CI, 64.35-1457.80; p < 0.001), higher HbA1c (%, OR, 1.97, 95% CI, 1.46-2.67; p < 0.001), higher serum creatinine (mg/dL, OR, 1.62, 95% CI, 1.06-2.50; p = 0.027), older age (years, OR, 1.12; 95% CI, 1.06-1.17; p < 0.001), higher pulse pressure (mmHg, OR, 1.03; 95% CI, 1.00-1.06; p = 0.025), lower cholesterol (mg/dL, OR, 0.94; 95% CI, 0.92-0.97; p < 0.001), lower BMI (kg/m2, OR, 0.87, 95% CI, 0.75-1.00; p = 0.044) and lower hematocrit (%, OR, 0.80, 95% CI, 0.74-0.87; p < 0.001) were associated with DFUs. In a subgroup analysis of DFU patients, the PDR group had a longer duration of diabetes mellitus, higher serum BUN, and higher serum creatinine than the non-PDR group. In the multivariable analysis, only higher serum creatinine was associated with PDR in DFU patients (OR, 1.37; 95% CI, 1.05-1.78; p = 0.021).
CONCLUSIONS:
Diabetic retinopathy is prevalent in patients with DFU and about half of DFU patients had PDR. No significant association was found in terms of the severity of these two diabetic complications. To prevent blindness, patients with DFU, and especially those with high serum creatinine, should undergo retinal examinations for timely PDR diagnosis and management.
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NewsBot · Nov 9, 2017

Genetic predictors associated with diabetic retinopathy in diabetic foot patients - a preliminary study.
Mrozikiewicz-Rakowska B, Łukawska M, Nehring P, Szymański K, Sobczyk-Kopcioł A, Krzyżewska M, Maroszek P, Płoski R, Czupryniak L.
Pol Arch Intern Med. 2017 Nov 7. doi: 10.20452/pamw.4144.

INTRODUCTION Early detection of diabetic retinopathy (DR) is key for preventing irreversible blindness. Recent research has identified some of the genetic factors involved in the pathology of DR, although their precise underlying mechanisms remain unclear. OBJECTIVES This pilot study aimed to determine genetic predictors of DR among patients with type 2 diabetes mellitus (T2DM) and diabetic foot (DF) based on pathogenetic pathways. PATIENTS AND METHODS The study was conducted on 114 patients with T2DM and DF (64 with DR, 50 without DR) treated in the Medical University of Warsaw. Genetic analysis was performed for each patient and the following polymorphisms were analyzed: rs759853 (AKR1B1), rs1800469 (TGFB1), rs2073618 and rs3134069 (TNFRSF11B), rs6330 and rs11466112 in (NGF), rs1801133 (MTHFR), rs8192678 (PPARGC1A), rs1799983 (NOS3) rs1553005 (CALCA) and 121917832 (CDKN1B). RESULTS Significant correlations with DR were identified for the following single nucleotide polymorphisms (SNPs): rs759853, rs2073618 and rs3134069. Carriers of the G allele of rs759853 had higher risk of DR in a dominant model (odds ratio [OR]=3.0; 95% confidence interval [CI] = 1.15-7.81; P = 0.02). We analyzed two SNPs of the osteoprotegerin gene (rs3134069 and rs2073618), and found the A allele of the rs3134069 decreased the risk of DR in both recessive and additive models (OR = 3.33; 95%CI = 1.07-10.3; P = 0.04). Conversely, there were fewer C carriers of the rs2073618 polymorphism in patients with DR in a dominant model (OR = 0.28; 95%CI = 0.09-0.92; P = 0.04). CONCLUSIONS The results of our study suggest the SNPs rs759853, rs3134069 and rs2073618 may be involved in the development of DR among patients with T2DM and DF.
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NewsBot · Mar 31, 2018

Diabetic retinopathy in patients with diabetic foot syndrome in South India.
Karam T, Kamath YS, Rao LG, Rao KA, Shenoy SB, Bhandary SV.
Indian J Ophthalmol 2018;66:547-50

Purpose: The purpose was to study the retinopathy status in diabetic patients with a risk of diabetic foot (DF) syndrome visiting a tertiary care hospital in South India. Methods: In this cross sectional study all patients with diabetes mellitus (DM) with a risk of DF syndrome, visiting a tertiary care hospital during the study period, underwent an ophthalmological evaluation for documentation of their retinopathy status. Results: One hundred and eighty-two patients diagnosed to have a risk profile for DF syndrome were included in the study. Their mean age was 59.28 years and 75.27% were males. The mean duration of Type 1 and Type 2 variants of DM was 14.9 years and 10.9 years, respectively. Of the 182 patients, 67.58% had retinopathy changes. Proliferative diabetic retinopathy (DR) constituted 17.88% of the total patients with retinopathy. An increased presence of retinopathy in patients with an increased risk grade of DF was found significant by the Chi-square test (P < 0.001). Conclusion: Our study found an increased presence of DR in a South Indian cohort with DF syndrome. The severity of retinopathy was greater in patients with higher grades of risk for DF. The establishment of an association between DR and DF syndrome will help in developing an integrated management strategy for these two debilitating consequences of diabetes.
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NewsBot · May 25, 2018

Presence of chronic diabetic foot ulcers is associated with more frequent and more advanced retinopathy.
Sellman A et al
Diabet Med. 2018 May 23.

AIMS:
To clarify the frequency and severity of diabetic retinopathy in a group of people with Type 2 diabetes and chronic diabetic foot ulcers, and to compare visual acuity, levels of retinopathy and clinical significant macular oedema with a matched control group of people with Type 2 diabetes without a history of chronic diabetic foot ulcers.

METHODS:
Visual acuity and fundus imaging were evaluated in 90 white people with at least 3 months' duration of full-thickness diabetic foot ulcers below the ankle and the results compared with those in 180 white people with Type 2 diabetes without a history of chronic diabetic foot ulcers (control group). Controls were matched for age, sex and duration of diabetes.

RESULTS:
Despite similar age and diabetes duration, severe non-proliferative or proliferative diabetic retinopathy was present in 41% of the people in the diabetic foot ulcer group as compared to 15% in the control group (P<0.001). Only 6% in the diabetic foot ulcer group was without any diabetic retinopathy as compared to 34% among controls. Proliferative diabetic retinopathy was more common in the diabetic foot ulcer group (31% vs 8%; P<0.001), but time-to-proliferative diabetic retinopathy did not differ between groups. Clinically significant macular oedema was more frequently present, and the diabetic foot ulcer group exhibited significantly worse results in best and worst eye visual acuity testing.

CONCLUSIONS:
In this northern European setting almost all people with Type 2 diabetes and chronic diabetic foot ulcers had diabetic retinopathy. Almost one-third had proliferative diabetic retinopathy as compared to <10% in our matched control group. More advanced diabetic retinopathy was linked to worse visual acuity
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NewsBot · Aug 8, 2018

Factors Associated with Non-compliance for Diabetic Retinopathy Follow-up in an Urban Safety-Net Hospital.
Chen AJ et al
Ophthalmic Epidemiol. 2018 Aug 6:1-8.

PURPOSE:
Diabetic retinopathy (DR) is the leading cause of preventable blindness in working-aged adults, and compliance in ophthalmic follow-up appointments is critical to prevent vision loss. However, barriers to follow-up care have not been well studied, especially in socio-economically disadvantaged groups. We investigated the risk factors for non-compliance to DR follow-up appointments in a safety-net county hospital.

METHODS:
Two hundred and nine patients who were treated for DR at the Zuckerberg San Francisco General Hospital retina clinic between 1 July 2015 and 30 January 2016 were enrolled in the study. Multivariate logistic regression analysis of demographic and medical information was used to determine independent risk factors for non-compliance to DR follow-up appointments.

RESULTS:
The mean patient age was 58 years. Sixty-three percent (132/209) of patients were male; the mean haemoglobin A1c level was 8.5 (SD 0.14). Forty-six percent (97/209) of patients attended <80% of their DR follow-up appoinments. Independent risk factors for non-compliance after multivariate logistic regression analysis were diabetic foot involvement [OR: 2.40, 95% CI: (1.04-5.55)] and foot/kidney involvement [OR: 3.79 (1.35-10.5)], history of major depressive disorder (MDD) [OR: 2.11 (1.05-4.26), and having Medi-Cal [OR: 5.01 (2.00-12.5)] or SF Health insurance [OR: 6.79 (2.14-21.5)].

CONCLUSIONS AND RELEVANCE:
In conclusion, this is the first study to identify diabetic end organ damage and MDD as independent risk factors for non-compliance in DR follow-up appointments. It is important that health care providers identify these patient subsets and increase efforts to more deliberately encourage follow-up in these high-risk patient groups for DR.
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NewsBot · Oct 16, 2018

Prevalence of Chronic Microvascular Complications and Diabetic Foot Problems in Patients with Diabetes Mellitus at Siriraj Hospital
Laotaveerungrueng N , Wanthong S , Wannachalee T , Lertwattanarak R Mail
J Med Assoc Thai 2018; 101 (10):1349-55

Background: The chronic disease diabetes mellitus [DM] and its associated complications substantially increase morbidity and mortality, resulting in major burdens on healthcare systems. Early detection and prevention of DM-related complications have proven to be cost-saving and cost-effective.

Objective: 1) To determine the prevalence of each microvascular complication in patients with DM at Siriraj Hospital and 2) To determine the factors associated with each microvascular complication.

Materials and Methods: In this cross-sectional observational study, the authors recruited patients with type 1 and type 2 DM who attended the diabetes clinic at Siriraj Hospital between January 1, 2012 and December 31, 2013 by searching the hospital database. Subjects who had been treated at the clinic for less than 12 months were excluded. Data was collected from the medical records for the 12 months preceding each patient’s last visit.

Results: The study included 430 patients. The majority were female; tended to be aged 60 years or older; had a long duration of type 2 DM (more than 10 years); were either pre-obese (BMI 23.0 kg/m2 or more but less than 24.9 kg/m2) or obese (BMI of 25.0 kg/m2 or more); and had the co-morbidities of hypertension [HT] and dyslipidemia. The mean fasting plasma glucose [FPG] and HbA1C were 147 mg/dl and 7.93%, respectively. The prevalence of diabetic nephropathy [DN], diabetic retinopathy [DR], and diabetic foot were 38.8% (95% CI 33.7 to 44), 40.4% (95% CI 35.7 to 45.3), and 39.1% (95% CI 34.4 to 43.9), respectively. The factors associated with DN were insulin use, HbA1C greater than 7%, HT, DR, and diabetic foot. Those associated with DR were insulin use, HbA1C greater than 7%, HT, an old cerebrovascular accident [CVA], DM duration longer than five years, DN and diabetic foot. The factors associated with diabetic foot were insulin use, HbA1C greater than 7%, duration of DM of longer than five years, smoking, type of DM (type 2 DM), coronary artery disease [CAD], DN and DR.

Conclusion: The prevalence of DN, DR, and diabetic foot were 38.8%, 40.4%, and 39.1%, respectively. Diabetic microvascular complications are common and are associated with poor glycemic control (HbA1C greater than 7%), insulin use, a long duration of diabetes, HT, and the presence of other microvascular complications.
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NewsBot · Jun 16, 2020

Association between diabetic retinopathy and diabetic foot ulcer in South Texas
Ansel Hoang; Jeong-Hyeon Sohn; Alexander Foster
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 4838

Purpose : The purpose of this study was to investigate the prevalence of diabetic retinopathy (DR) in patients with diabetic foot ulcer (DFU) in South Texas and study the association of DR severity and DFU.

Methods : A retrospective review was done on patients visiting a tertiary center in San Antonio that were diagnosed with DFU and underwent ophthalmic and vascular examinations within 5 years; 78 diabetic eyes were included. DR prevalence and severity was assessed in DFU patients.

Results : Of 78 eyes at the initial visit, there were 39 subjects total; 16 subjects had PDR, 20 had NPDR, 1 was with both PDR and NPDR, and 2 had no diabetic retinopathy. At the final visit, with the follow up period of 42.4 + 19.9 months, 25 subjects had PDR, 11 had NPDR, and 3 were mixed. The average age of the study group was 58.7 years old and was 55% male, 45% female, 82.5% Hispanic, and 12.5% White.

Over the course of the study, 9 subjects (45%) showed the development of PDR; 8 subjects (15 eyes; 40%) developed PDR from NPDR, and 1 subject (1 eye) developed PDR from no prior retinopathy.

Of eyes that started with PDR and DFU, the initial Log MAR was 0.66 + 0.37 and the final Log MAR was 0.52 + 0.31, with a total change of -0.14 + 0.41. Of eyes that started with NPDR and DFU, the initial Log MAR was 0.53 + 0.29 and the final Log MAR was 0.52 +0.36, with a total change of -0.0125 +0.3.

Conclusions : DFU is related with the development of advanced diabetic retinopathy. A better understanding of the relationship between DR and DFU will help in creating a coordinated approach to managing these debilitating diabetes conditions. Patients with DFU should undergo timely retinal examinations and management to prevent premature blindness from PDR. This will aid in future diabetes care.
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NewsBot · Aug 13, 2020

Combining diabetic foot and retinopathy screening: A step in the right direction? - a feasibility study
Jane Ea Lewis et al
SAGE Open Med. 2020 Jul 28;8:2050312120946244

Objectives: Peripheral artery disease is a major cardiovascular disease affecting more than 200 million people globally and up to 4 times more frequent in the diabetic population. It can lead to lower extremity amputations or revascularisation and is associated with an increased risk of myocardial infarction, stroke and early mortality. This novel cross-sectional study aimed to explore the feasibility and acceptability of incorporating diabetic foot screening at routine diabetic retinopathy screening appointments.

Methods: Participants underwent foot screening during the interval between pupil dilatation and retinal photography as part of the eye screening procedure. Lower limb arterial assessment included ankle brachial index, pulse volume waveform and protective light touch sensation.

Results: Of 364 participants invited, 88% (n = 321) met the inclusion criteria. About 26.4% (n = 86) had asymptomatic peripheral artery disease and 3% (n = 10) had peripheral sensory neuropathy. Binary logistical regression analysis identified age (p < 0.005), existing coronary heart disease (p < 0.005) and gender (p = 0.03) as predictors of peripheral artery disease.

Conclusion: Incorporating foot examination during eye screening appointments is feasible and was well received by participants and staff alike. Undiagnosed early peripheral artery disease was evident in a third of the study population emphasising the benefit of introducing foot surveillance into eye screening appointments for the early identification of lower limb arterial disease and peripheral sensory neuropathy.
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NewsBot · Jun 14, 2022

Incidence of interventions for diabetic retinopathy and serious lower-limb complications and its related factors in patients with type 2 diabetes using a real-world large claims database
Ayako Yanagisawa-Sugita et al
Diabetol Int. 2022 Jan 13;13(3):548-560

Aims: To examine the incidence of interventions for diabetic retinopathy and serious limb complications and to elucidate the patient attributes related to the incidence of each intervention based on real-world claims data from Japan.

Materials and methods: A retrospective longitudinal study design involving a 9 year (2009-2018) claims database obtained from the JMDC Inc. Patients with type 2 diabetes aged 20-74 years taking antidiabetic medications were divided into two groups: "patients with newly initiated antidiabetic medication" (Group 1, n = 47,201) and "patients with continuing antidiabetic medication" (Group 2, n = 82,332). The incidence rate for each intervention was analyzed. We also divided Group 1 into the former and latter periods and investigated temporal changes.

Results: The incidences of the first retinopathy intervention (laser photocoagulation, vitrectomy, or intraocular injection), vitrectomy, and lower-limb amputations in Group 1 were 7.46, 2.37, and 0.31 /1000 person-years, respectively. Those in Group 2 were about 1.2-1.5 times higher. Older age, insulin use, and being dependents rather than insured persons were associated with a higher incidence in both groups after adjustment. While the incidence of the interventions for retinopathy hardly changed during the observation period, that of lower-limb amputations decreased by 40%, with less statistical significance (p = 0.11).

Conclusions: We showed the incidences of the first retinopathy interventions and lower-limb amputations and their secular trends in patients with diabetes, stratified by whether the antidiabetic medication was newly initiated or not. Older age, insulin use, and being dependents were risk factors of these interventions for diabetic complications.
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NewsBot · Jan 17, 2023

Keeping an eye on the diabetic foot: The connection between diabetic eye disease and wound healing in the lower extremity
David J Ramsey et al
World J Diabetes. 2022 Dec 15;13(12):1035-1048

Diabetic eye disease is strongly associated with the development of diabetic foot ulcers (DFUs). DFUs are a common and significant complication of diabetes mellitus (DM) that arise from a combination of micro- and macrovascular compromise. Hyperglycemia and associated metabolic dysfunction in DM lead to impaired wound healing, immune dysregulation, peripheral vascular disease, and diabetic neuropathy that predisposes the lower extremities to repetitive injury and progressive tissue damage that may ultimately necessitate amputation. Diabetic retinopathy (DR) is caused by cumulative damage to the retinal mic-rovasculature from hyperglycemia and other diabetes-associated factors. The severity of DR is closely associated with the development of DFUs and the need for lower extremity revascularization procedures and/or amputation. Like the lower extremity, the eye may also suffer end-organ damage from macrovascular compromise in the form of cranial neuropathies that impair its motility, cause optic neuropathy, or result in partial or complete blindness. Additionally, poor perfusion of the eye can cause ischemic retinopathy leading to the development of proliferative diabetic retinopathy or neovascular glaucoma, both serious, vision-threatening conditions. Finally, diabetic corneal ulcers and DFUs share many aspects of impaired wound healing resulting from neurovascular, sensory, and immunologic compromise. Notably, alterations in serum biomarkers, such as hemoglobin A1c, ceruloplasmin, creatinine, low-density lipoprotein, and high-density lipoprotein, are associated with both DR and DFUs. Monitoring these parameters can aid in prognosticating long-term outcomes and shed light on shared pathogenic mechanisms that lead to end-organ damage. The frequent co-occurrence of diabetic eye and foot problems mandate that patients affected by either condition undergo reciprocal comprehensive eye and foot evaluations in addition to optimizing diabetes management.
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NewsBot · Jan 18, 2023

Diabetic retinopathy relates to the incidence of foot ulcers and amputations in type 2 diabetes
Gauthier Borderie et al
Diabetes Metab Res Rev. 2022 Dec 27

Aims: We investigated whether Diabetic Retinopathy (DR) is related to Diabetic Foot Ulcer (DFU) development, adjusted for the stratification of the International Work Group on Diabetic Foot (IWGDF) guidance.

Materials and methods: DR and IWGDF stratification was registered retrospectively in patients hospitalised from 2009 to 2017 for uncontrolled and/or complicated type 2 diabetes. New DFUs were registered until 2020. Survival analyses categorised the subjects for DR, and multivariate Cox regression adjusted for confounders.

Results: The 522 patients (57.9% male) were 62 ± 9 years old with a diabetes duration of 14 ± 10 years, HbA1c of 8.7 ± 1.8%, 33.9% macroangiopathies and 44.8% diabetic kidney diseases. Their grades of DFU risk were 0 for 43.3%, 1 for 23.9%, 2 for 7.1%, and 3 for 25.6%. During the 52 months follow-up (Inter Quartile Range: 32-71), 58 new DFUs and 18 lower-limb amputations occurred, mostly in patients with DR present in 140 (26.8%) patients. Adjusted for age, sex and conventional risk factors (duration and control of diabetes, arterial hypertension, and dyslipidemia), and other complications (macroangiopathy and diabetic kidney disease), DR was associated with a greater incidence of DFUs. Adjusted for the IWGDF classification, DR was related to new DFUs (HR: 2.51, 95%Confidence Interval [CI]: 1.48-4.26) and amputations (HR: 3.56, 95%CI: 1.26-10.07). This relationship persisted in ascending IWGDF grades with incidences of DFUs from 2/1000 (grade 0, no DR) to 121/1000 patient-years (grade 3 and DR) and amputations from 0 (grade 0, no DR) to 38/1000 patient-years (grade 3 and DR).

Conclusions: Diabetic retinopathy independently relates to the incidence of foot ulcers and amputations in patients hospitalised for type 2 diabetes
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NewsBot · Jan 19, 2023

Impact of microvascular complications on the outcomes of diabetic foot in type 2 diabetic patients with documented peripheral artery disease
Carmine Gazzaruso et al
Endocrine. 2022 Dec 24

Purpose: Microvascular disease (MVD) is associated with amputation linked to peripheral artery disease (PAD) in the general population. No study evaluated the impact of diabetic microvascular complications on the outcomes of vascular diabetic foot ulcers (DFU). The aim of the study was to investigate whether retinopathy, nephropathy, and polyneuropathy can predict the outcomes of DFU in type 2 diabetic patients with PAD.

Methods: Three hundred and thirty-one consecutive patients with vascular DFU were enrolled and followed up for 44.1 ± 23.9 months.

Results: The prevalence of retinopathy was significantly higher in subjects with ulcer persistence (45.2%; p < 0.01), minor amputation (48.9%; p < 0.001), and major amputation (57.9%; p < 0.001) than in healed patients (23.3%), and in non-survivors than in survivors (64.9 versus 20.5%; p < 0.001). The prevalence of nephropathy was significantly greater in subjects with ulcer persistence (83.9%; p < 0.01), minor amputation (86.7%; p < 0.001), and major amputation (94.7%; p < 0.001) than in those with healed DFU (64.4%), and in non-survivors than in survivors (88.3 versus 65.7%; p < 0.001). The prevalence of polyneuropathy was significantly higher in non-survivors than in survivors (76.6 versus 61.0%; p = 0.012). Multivariate analysis showed that absence of retinopathy (OR: 0.451; 95% CI: 0.250-0.815; p < 0.001) and nephropathy (OR: 0.450; 95% CI: 0.212-0.951; p = 0.036) were independently associated with healing. Moreover, retinopathy was a predictor both of minor amputation (OR: 2.291; 95% CI: 1.061-4.949; p = 0.034) and mortality (OR: 5.274; 95% CI: 2.524-11.020; p < 0.001). Polyneuropathy never entered the regression model.

Conclusions: Diabetic microvascular complications, in particular retinopathy, may predict the outcomes of vascular DFU. Longitudinal studies should confirm this finding.
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NewsBot · Aug 10, 2023

Association between diabetic retinopathy and diabetic foot ulcer in patients with diabetes: A meta-analysis
Ziye Li, Jing Wei, Song Lu
Int Wound J. 2023 Aug 9

This study aimed to explore the relationship between diabetic retinopathy (DR) and diabetic foot ulcers (DFUs) to provide evidence for the prevention of diabetic complications. PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wanfang Data databases were searched from their inception until March 2023 for studies on the relationship between DR and DFU. Two researchers independently screened the literature and extracted data according to the inclusion and exclusion criteria. The meta-analysis was performed using the RevMan 5.3 software. Eleven articles referring to 10 208 patients were included, of whom 2191 patients had DFU and 8017 patients did not have DFU. The meta-analysis results showed that DR significantly increased the incidence of DFU (47.94% vs. 16.38%; OR, 4.13; 95% CI, 2.33-7.33; p < 0.001). The results of this study suggest that patients with DR have a higher risk of developing DFU, highlighting the importance of regular screening for these two complications to prevent serious adverse outcomes of diabetes. However, further high-quality studies are required to validate the conclusions of the present study.
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NewsBot · Sep 11, 2023

Corneal Confocal Microscopy Predicts Cardiovascular and Cerebrovascular Events and Demonstrates Greater Peripheral Neuropathy in Patients with Type 1 Diabetes and Foot Ulcers
Jonathan Z M Lim et al
Diagnostics (Basel). 2023 Aug 29;13(17):2793

Objective: In this study, we evaluate small and large nerve fibre pathology in relation to diabetic foot ulceration (DFU) and incident cardiovascular and cerebrovascular events in type 1 diabetes (T1D).

Methods: A prospective observational study was conducted on people with T1D without diabetic peripheral neuropathy (DPN) (n = 25), T1D with DPN (n = 28), T1D with DFU (n = 25) and 32 healthy volunteers. ROC analysis of parameters was conducted to diagnose DPN and DFU, and multivariate Cox regression analysis was performed to evaluate the predictive ability of corneal nerves for cardiac and cerebrovascular events over 3 years.

Results: Corneal nerve fibre length (CNFL), fibre density (CNFD) and branch density (CNBD) were lower in T1D-DPN and T1D-DFU vs. T1D (all p < 0.001). In ROC analysis, CNFD (sensitivity 88%, specificity 87%; AUC 0.93; p < 0.001; optimal cut-off 7.35 no/mm2) and CNFL (sensitivity 76%, specificity 77%; AUC 0.90; p < 0.001; optimal cut-off 7.01 mm/mm2) had good ability to differentiate T1D with and without DFU. Incident cardiovascular events (p < 0.001) and cerebrovascular events (p < 0.001) were significantly higher in T1D-DPN and T1D-DFU. Corneal nerve loss, specifically CNFD predicted incident cardiovascular (HR 1.67, 95% CI 1.12 to 2.50, p = 0.01) and cerebrovascular (HR 1.55, 95% CI 1.06 to 2.26, p = 0.02) events.

Conclusions: Our study provides threshold values for corneal nerve fibre metrics for neuropathic foot at risk of DFU and further demonstrates that lower CNFD predicts incident cardiovascular and cerebrovascular events in T1D.
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NewsBot · Apr 3, 2024

How have services for diabetes, eye, hearing and foot health been integrated for adults? Protocol for a scoping review
Claire O'Shea et al
BMJ Open. 2024 Mar 14

Introduction: The global population is ageing, and by 2050, there will be almost 2.1 billion people over the age of 60 years. This ageing population means conditions such as diabetes are on the increase, as well as other conditions associated with ageing (and/or diabetes), including those that cause vision impairment, hearing impairment or foot problems. The aim of this scoping review is to identify the extent of the literature describing integration of services for adults of two or more of diabetes, eye, hearing or foot services.

Methods and analysis: The main database searches are of Medline and Embase, conducted by an information specialist, without language restrictions, for studies published from 1 January 2000 describing the integration of services for two or more of diabetes, eye, hearing and foot health in the private or public sector and at the primary or secondary level of care, primarily targeted to adults aged ≥40 years. A grey literature search will focus on websites of key organisations. Reference lists of all included articles will be reviewed to identify further studies. Screening and data extraction will be undertaken by two reviewers independently and any discrepancies will be resolved by discussion. We will use tables, maps and text to summarise the included studies and findings, including where studies were undertaken, which services tended to be integrated, in which sector and level of the health system, targeting which population groups and whether they were considered effective.

Ethics and dissemination: As our review will be based on published data, ethical approval will not be sought. This review is part of a project in Aotearoa New Zealand that aims to improve access to services for adults with diabetes or eye, hearing or foot conditions. The findings will be published in a peer-reviewed journal and presented at relevant conferences.
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'Diabetic foot' record in the Guiness World Records

New 'Diabetic foot' journal

Blood flow in different types of 'diabetic foot'

Genu valgum & 'flat foot' but lateral deviation of STJ and low supination resistance??

Patent granted for 'barefoot' simulating running shoe

New 'barefoot' running shoe from Nike

Robin Williams suicide caused by 'Rothbarts foot'

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