Prevalence of Diabetic Foot Disease in Patients with Diabetes Mellitus under Renal Replacement Therapy in Lleida, Spain

Aim. To assess the prevalence of diabetic foot and other associated conditions in patients with diabetes mellitus under renal replacement in the region of Lleida, Spain.Methods. This was an observational, cross-sectional study of 92 dialysis-treated diabetic patients. Besides a podiatric examination, we explored the presence of cardiovascular risk factors, late diabetes complications, including peripheral neuropathy, atherosclerotic disease, and peripheral artery disease. We assessed risk factors for foot ulceration and amputation by logistic regression.Results. Prevalent diabetic foot was found in 17.4% of patients, foot deformities were found in 54.3%, previous ulcer was found in 19.6%, and amputations were found in 16.3%; and 87% of them had some risk of suffering diabetic foot in the future. We observed a high prevalence of patients with peripheral neuropathy and peripheral artery disease (89.1% and 64.2%, resp.). Multivariable analysis identified diabetic retinopathy and advanced atherosclerotic disease (stenosing carotid plaques) as independent risk factors for foot ulceration (p=0.004andp=0.023, resp.) and diabetic retinopathy also as an independent risk factor for lower-limb amputations (p=0.013). Moreover, there was a temporal association between the initiation of dialysis and the incidence of amputations.Conclusion. Diabetic patients receiving dialysis therapy are at high risk of foot complications and should receive appropriate and intensive foot care.

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Knowledge of Risk Factors for Foot Ulceration among Patients with Diabetes Mellitus Attending a Tertiary Health Facility in Nigeria

Iranian journal of diabetes and obesity ◽

10.18502/ijdo.v13i3.7184 ◽

2021 ◽

Author(s):

Martins Ehizode Emuze ◽

Taoreed Adegoke Azeez ◽

Arinola Esan ◽

Jokotade Adeleye ◽

William Balogun ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Health Facility ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Diabetic Patients ◽

Foot Ulceration ◽

Validated Questionnaire ◽

Patients With Diabetes

Objective: Diabetic foot ulcer (DFU) is a relatively common complication of diabetes mellitus and constitutes a major cause of mortality. This study aimed to assess the knowledge of risk factors for foot ulceration among patients with diabetes in a tertiary health facility in South Western Nigeria. Materials and Methods: This cross-sectional study was initiated with participation of 100 diabetic patients. Diabetic patients were attending the medical outpatient clinic of the University College Hospital, Ibadan. A structured and validated questionnaire was administered and data was analyzed using SPSS 22. Association between sociodemographic characteristics and knowledge of risk factors for foot ulceration was evaluated by chi-square test. Results: Most of respondents were female (66%). The mean age of the patients was 58.77 (±11.8) years and 51% of patients did not know that it is possible to develop foot ulcer without feeling pain and 30% did not know that features suggestive of neuropathy could be associated with development of foot ulcer. 75% did not know that surgical vascular repair could play any role in the healing of a diabetic foot ulcer. 11% of patients were walking barefooted at home and as much as 63% of respondents did not know that poor longterm glycemic control could be a risk factor for the development of diabetic foot ulcers. Conclusion: The knowledge of the patients attending the diabetes clinic of a tertiary hospital in south-western Nigeria on foot care is generally poor. Education in this direction is very paramount to correct this defect.

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Risk factors for eye complications in patients with diabetes mellitus: development and progression

Eastern Mediterranean Health Journal ◽

10.26719/2000.6.2-3.313 ◽

2000 ◽

Vol 6 (2-3) ◽

pp. 313-325

Author(s):

M. El Shazly ◽

M. Zeid ◽

A. Osman

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Diabetic Retinopathy ◽

Case Control Study ◽

Case Control ◽

Diabetic Patients ◽

Patients With Diabetes ◽

Control Study

A multicentre case-control study was conducted to identify and quantify risk factors that may influence the development and progression of diabetic retinopathy. A total of 200 diabetic patients with nonproliferative retinopathy were compared with 400 diabetic patients without any eye complications with regard to the development of diabetic retinopathy. They were also compared with 200 diabetic patients with major eye complications to study the progression of diabetic eye complications. Results showed that the progression of diabetic eye complications was preventable since all the variables significantly affecting the process of progression, except type of diabetes, were avoidable

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The Neuro-Vascular Consequence of Diabetes: Foot Amputation and Evaluation of its Risk Factors and Health-Related Economic Impact

Current Vascular Pharmacology ◽

10.2174/1570161118666200320112401 ◽

2020 ◽

Vol 19 (1) ◽

pp. 102-109

Author(s):

Iftikhar Haider Naqvi ◽

Abu Talib ◽

Sajjad Haider Naqvi ◽

Lubabah Yasin ◽

Nayema Zehra Rizvi

Keyword(s):

Risk Factors ◽

Peripheral Neuropathy ◽

Peripheral Artery Disease ◽

Diabetic Foot ◽

Financial Burden ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Peripheral Artery ◽

Health Related ◽

Artery Disease

Background: The rising prevalence of type 2 diabetes mellitus (T2DM) with the huge burden of diabetic foot amputation is a challenge to the health economy of Pakistan and other countries. Identification of various risk factors for amputation, along with its financial burden, is needed to address this problem. Objectives: This study aimed to determine the financial burden and risk factors associated with T2DMrelated foot amputation. Methods: Retrospective hospital-based study from January 2017 to December 2018. Patients with T2DM with and without amputation were enrolled. The direct medical costs of amputation along with various risk factors, were determined. Risk factors were evaluated by logistic regression analysis. Results: A total of 1460 patients with T2DM were included; 484 (33%) patients had an amputation. The mean total cost of below knee, fingers and toe amputation was 886.63±23.91, 263.35 ±19.58 and 166.68 ± 8.47 US$, respectively. This difference among groups was significant (p<0.0001). Male gender (odds ratio, OR: 1.29, 1.01-1.63, p=0.037), peripheral artery disease (OR: 1.93, 1.52-2.46, p=0.000), peripheral neuropathy (OR: 1.31, 1.40-1.63, p=0.000), prior diabetic foot ulcer (OR: 2.02, 1.56- 2.56, p=0.000) and raised glycated haemoglobin (HbA1c) (OR: 3.50, 2.75-4.4, p=0.000) were risk factors for amputation. Conclusion: The health-related financial impact of amputations is high. Peripheral artery disease, peripheral neuropathy, prior diabetic foot ulcer and raised HbA1c were risk factors for amputation.

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The risk factors of developing diabetic foot ulcers incidence with diabetic patients in Mukalla/Yemen

Sudan Journal of Medical Sciences ◽

10.18502/sjms.v15i2.6750 ◽

2020 ◽

Author(s):

مريم باراس ◽

Eidha A. Bin Hameed

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Blood Glucose ◽

Bacterial Infection ◽

Diabetic Foot ◽

Age Groups ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Diabetic Patients ◽

Patients With Diabetes

Background: Diabetes is on the rise worldwide and is already considered as an epidemic by some experts. So, there is a need to raise awareness on the important factors that can help prevent bacterial infection in wounds of patients with diabetes. Objective: To study the risk factors of developing diabetic foot ulcer (DFU) in patients with diabetes. The study is the first in Yemen to investigate the prevalence of bacterial infection in wounds of diabetic patients. Materials and Methods: This is a case-control study carried out from November 2018 to May 2019. Twenty diabetic patients with foot ulcer and twenty without foot ulcer were examined. Risk factors and clinical profile of patients were studied by using a standardized questionnaire that included gender, age groups, past history of diabetes, duration of the disease, type of diabetes, DFU, type of ulcer, smoking, glucose level, and control of blood glucose level. Results: The risk factors that affected significantly the occurrence of DFU were gender (0.038), age groups (0.010), and duration of diabetes mellitus (DM) while hyperglycemic control, smoking, and family history were not. There was no significant difference (0.977) in mean fasting blood glucose (MBG) between the DM and DFU patients. Conclusions: Male diabetic patients aged more than 55 years and suffering from DM for more than 10 years were most likely to have DFU. Key words: diabetic foot ulcer, diabetes mellitus, risk factors, Yemen

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Prevalence of diabetic peripheral neuropathy in patients with type 2 diabetes mellitus at a tertiary referral centre in Singapore

Proceedings of Singapore Healthcare ◽

10.1177/2010105820978993 ◽

2020 ◽

pp. 201010582097899

Author(s):

Arnold Hu Hanquan ◽

Melissa-Raye Teo Li Wen

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Peripheral Neuropathy ◽

Diabetic Foot ◽

Diabetic Foot Screening ◽

Insulin Use

Background: There is a lack of data regarding prevalence estimates of diabetic peripheral neuropathy (DPN) in Singapore. This study aimed to investigate the prevalence of DPN and risk factors in patients who present to a diabetic foot screening clinic and are considered low to medium risk in developing foot complications due to their type 2 diabetes mellitus. Methods: A one-year retrospective analysis was conducted at Ng Teng Fong General Hospital. Patients who underwent diabetic foot screening and endocrinologist review in the Diabetes and Endocrinology Specialist Outpatient Clinic during the period January 2019–December 2019 were included in this study. DPN was defined by the patient’s inability to detect ⩾1 out of 10 sites using the 10 g monofilament. Significantly associated risk factors with DPN were analysed using a multivariable logistic regression model. Results: Data from 479 patients were analysed. Prevalence of DPN was 28% (95% confidence interval (CI) 24.0–32.2). DPN was significantly associated with age >65 years (odds ratio (OR)=5.44, 95% CI 2.87–10.32), Indian ethnicity (OR=1.99, 95% CI 1.04–3.80), insulin use (OR=1.65, 95% CI 1.03– 2.64), diabetic retinopathy (OR=2.36, 95% CI 1.47–3.78) and stroke (OR=2.44, 95% CI 1.03–5.77). Conclusion: Prevalence of DPN in this study’s population sample was 28%, and the significant risk factors are age, Indian ethnicity, insulin use, diabetic retinopathy and stroke.

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Glycated Hemoglobin (HbA1c) as a Biomarker for Diabetic Foot Peripheral Neuropathy

Diseases ◽

10.3390/diseases9010016 ◽

2021 ◽

Vol 9 (1) ◽

pp. 16

Author(s):

Giulia Casadei ◽

Marta Filippini ◽

Lorenzo Brognara

Keyword(s):

Diabetes Mellitus ◽

Peripheral Neuropathy ◽

Diabetic Foot ◽

Glycated Hemoglobin ◽

Chronic Inflammatory Demyelinating Polyneuropathy ◽

Glycemic Variability ◽

Future Research ◽

Patients With Diabetes ◽

Axonal Dysfunction ◽

Biomarker Research

Background: Diabetic peripheral neuropathy (DPN) is known to predict foot ulceration, lower-extremity amputation and mortality. Patients with diabetes mellitus have a predisposition toward developing chronic inflammatory demyelinating polyneuropathy, and this may also facilitate the formation of diabetic foot and cutaneous impairment, which are considered one of the most serious impairments of diabetes mellitus, with a prevalence of 4–10% in this population. Biomarkers research provides opportunities for the early diagnosis of these complications for specific treatments useful to prevent amputation and, therefore, physical inability and mental disturbance. The recent literature has suggested that glycemic levels may be a novel factor in the pathogenesis of diabetic foot complications and is an important mediator of axonal dysfunction. The aim of this systematic literary review is to determine whether hemoglobin A1c (HbA1c) is a positive predictor for diabetic foot peripheral neuropathy and its complications, such as foot cutaneous impairments. There is a lack of consensus regarding the effect of glycemic variability on diabetic foot peripheral neuropathy, unlike other complications such as retinopathy, nephropathy or micro/macrovascular pathology. Methods: Relevant articles were searched in the Medline database using PubMed and Scopus and relevant keywords. The primary search terms used were “glycated hemoglobin” OR “HbA1c” AND “diabetic neuropathies” AND “Foot”. Results: A number of articles (336) were initially identified while searching the scientific literature regarding this topic, and 32 articles were selected and included in this review. Conclusions: This review highlights the role of HbA1c in diabetic foot peripheral neuropathy. Biomarkers play an important role in the decision-making process, and HbA1c levels are extensively used for diabetic foot clinical outcomes and settings, but biomarker research in diabetic foot peripheral neuropathy is in its infancy and will require careful attention to a number of factors and associations, since the consequences of DPN also include neurological alterations. HbA1c is an accurate and easy-to-administer test and can be an effective biomarker in establishing the diagnosis of diabetes, but future research should focus on standardizing the HbA1c level and selecting which DPN value and its correlated complications, such as foot cutaneous impairments, are the most informative.

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When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis

Journal of Fungi ◽

10.3390/jof7040298 ◽

2021 ◽

Vol 7 (4) ◽

pp. 298

Author(s):

Teny M. John ◽

Ceena N. Jacob ◽

Dimitrios P. Kontoyiannis

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Clinical Features ◽

The Other ◽

Diabetic Patients ◽

Epidemiological Factors ◽

Uncontrolled Diabetes ◽

Diagnostic Certainty ◽

Patients With Diabetes ◽

Perfect Storm

Mucormycosis (MCR) has been increasingly described in patients with coronavirus disease 2019 (COVID-19) but the epidemiological factors, presentation, diagnostic certainty, and outcome of such patients are not well described. We review the published COVID-19-associated mucormycosis (CAMCR) cases (total 41) to identify risk factors, clinical features, and outcomes. CAMCR was typically seen in patients with diabetes mellitus (DM) (94%) especially the ones with poorly controlled DM (67%) and severe or critical COVID-19 (95%). Its presentation was typical of MCR seen in diabetic patients (mostly rhino-orbital and rhino-orbital-cerebral presentation). In sharp contrast to reported COVID-associated aspergillosis (CAPA) cases, nearly all CAMCR infections were proven (93%). Treating physicians should have a high suspicion for CAMCR in patients with uncontrolled diabetes mellitus and severe COVID-19 presenting with rhino-orbital or rhino-cerebral syndromes. CAMR is the convergence of two storms, one of DM and the other of COVID-19.

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Prevalence of Toenail Onychomycosis in Patients with Type 2 Diabetes Mellitus and Evaluation of Risk Factors

Journal of the American Podiatric Medical Association ◽

10.7547/1010049 ◽

2011 ◽

Vol 101 (1) ◽

pp. 49-54 ◽

Cited By ~ 12

Author(s):

Aynur Gulcan ◽

Erim Gulcan ◽

Sukru Oksuz ◽

Idris Sahin ◽

Demet Kaya

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Fasting Blood Glucose ◽

Diabetic Patients ◽

Essential Components ◽

Patients With Diabetes ◽

Epidemiologic Risk

Background: We sought to determine the frequency of toenail onychomycosis in diabetic patients, to identify the causative agents, and to evaluate the epidemiologic risk factors. Methods: Data regarding patients’ diabetic characteristics were recorded by the attending internal medicine clinician. Clinical examinations of patients’ toenails were performed by a dermatologist, and specimens were collected from the nails to establish the onycomycotic abnormality. All of the specimens were analyzed by direct microscopy and culture. Results: Of 321 patients with type 2 diabetes mellitus, clinical onychomycosis was diagnosed in 162; 41 of those diagnoses were confirmed mycologically. Of the isolated fungi, 23 were yeasts and 18 were dermatophytes. Significant correlations were found between the frequency of onychomycosis and retinopathy, neuropathy, obesity, family history, and duration of diabetes. However, no correlation was found with sex, age, educational level, occupation, area of residence, levels of hemoglobin A1c and fasting blood glucose, and nephropathy. The most frequently isolated agents from clinical specimens were yeasts. Conclusions: Long-term control of glycemia to prevent chronic complications and obesity and to promote education about the importance of foot and nail care should be essential components in preventing onychomycosis and its potential complications, such as secondary foot lesions, in patients with diabetes mellitus. (J Am Podiatr Med Assoc 101(1): 49–54, 2011)

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Current state-of-the-art antiplatelet and anticoagulation therapy in diabetic patients with coronary artery disease

Future Cardiology ◽

10.2217/fca-2021-0014 ◽

2021 ◽

Author(s):

Johny Nicolas ◽

Victor Razuk ◽

Gennaro Giustino ◽

Roxana Mehran

Keyword(s):

Diabetes Mellitus ◽

Complex Disease ◽

Anticoagulation Therapy ◽

Treatment Strategies ◽

Diabetic Patients ◽

Current State ◽

Organ Systems ◽

Patients With Diabetes ◽

The Status ◽

Artery Disease

Diabetes mellitus is a complex disease that leads to long-term damage to various organ systems. Among the numerous cardiovascular disease-related complications, thrombotic events frequently occur in patients with diabetes. Although guidelines exist for treating and preventing most diabetes-related co-morbidities, the evidence on antithrombotic therapy in primary and secondary prevention is limited due to the scarcity of randomized trials dedicated to patients with diabetes mellitus. Most of the available data are derived from studies that only included a small proportion of patients with diabetes. The present review provides an overview of the status of knowledge on antiplatelet and anticoagulation therapy in patients with diabetes, focusing on the risk–benefit balance of these therapies and future treatment strategies.

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