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

Diseases ◽  
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.

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

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Montserrat Dòria ◽  
Verónica Rosado ◽  
Linda Roxana Pacheco ◽  
Marta Hernández ◽  
Àngels Betriu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Peripheral Neuropathy ◽  
Diabetic Foot ◽  
Diabetic Patients ◽  
Peripheral Artery ◽  
Foot Ulceration ◽  
Patients With Diabetes ◽  
Artery Disease

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.

scholarly journals Quantifying dermal microcirculatory changes of neuropathic and neuroischemic diabetic foot ulcers using spatial frequency domain imaging: a shade of things to come?

2020 ◽  
Vol 8 (2) ◽  
pp. e001815
Author(s):  
Grant A Murphy ◽  
Rajinder P Singh-Moon ◽  
Amaan Mazhar ◽  
David J Cuccia ◽  
Vincent L Rowe ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Spatial Frequency ◽  
Oxygen Saturation ◽  
Diabetic Foot ◽  
Clinical Course ◽  
Tissue Oxygen Saturation ◽  
Tissue Oxygen ◽  
Spatial Frequency Domain Imaging ◽  
Patients With Diabetes ◽  
Spatial Frequency Domain

IntroductionThe use of non-invasive vascular and perfusion diagnostics are an important part of assessing lower extremity ulceration and amputation risk in patients with diabetes mellitus. Methods for detecting impaired microvascular vasodilatory function in patients with diabetes may have the potential to identify sites at risk of ulceration prior to clinically identifiable signs. Spatial frequency domain imaging (SFDI) uses patterned near-infrared and visible light spectroscopy to determine tissue oxygen saturation and hemoglobin distribution within the superficial and deep dermis, showing distinct microcirculatory and oxygenation changes that occur prior to neuropathic and neuroischemic ulceration.Research designs and methods35 patients with diabetes mellitus and a history of diabetic foot ulceration were recruited for monthly imaging with SFDI. Two patients who ulcerated during the year-long longitudinal study were selected for presentation of their clinical course alongside the dermal microcirculation biomarkers from SFDI.ResultsPatient 1 developed a neuropathic ulcer portended by a focal increase in tissue oxygen saturation and decrease in superficial papillary hemoglobin concentration 3 months prior. Patient 2 developed bilateral neuroischemic ulcers showing decreased tissue oxygen saturation and increased superficial papillary and deep dermal reticular hemoglobin concentrations.ConclusionsWounds of different etiology show unique dermal microcirculatory changes prior to gross ulceration. Before predictive models can be developed from SFDI, biomarker data must be correlated with the clinical course of patients who ulcerate while being followed longitudinally.Trial registration numberNCT03341559.

scholarly journals Glycemic variability and cardiovascular disease in patients with type 2 diabetes

2021 ◽  
Vol 9 (1) ◽  
pp. e002032
Author(s):  
Marcela Martinez ◽  
Jimena Santamarina ◽  
Adrian Pavesi ◽  
Carla Musso ◽  
Guillermo E Umpierrez
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glycated Hemoglobin ◽  
Glucose Monitoring ◽  
Glycemic Variability ◽  
Cardiovascular Complications ◽  
Glucose Levels ◽  
Increased Risk ◽  
Patients With Diabetes

Glycated hemoglobin is currently the gold standard for assessment of long-term glycemic control and response to medical treatment in patients with diabetes. Glycated hemoglobin, however, does not address fluctuations in blood glucose. Glycemic variability (GV) refers to fluctuations in blood glucose levels. Recent clinical data indicate that GV is associated with increased risk of hypoglycemia, microvascular and macrovascular complications, and mortality in patients with diabetes, independently of glycated hemoglobin level. The use of continuous glucose monitoring devices has markedly improved the assessment of GV in clinical practice and facilitated the assessment of GV as well as hypoglycemia and hyperglycemia events in patients with diabetes. We review current concepts on the definition and assessment of GV and its association with cardiovascular complications in patients with type 2 diabetes.

Surgical Off-loading of the Diabetic Foot

2010 ◽  
Vol 100 (5) ◽  
pp. 369-384 ◽  
Author(s):  
Robert G. Frykberg ◽  
Nicholas J. Bevilacqua ◽  
Geoffrey Habershaw
Keyword(s):  
Diabetes Mellitus ◽  
High Risk ◽  
Diabetic Foot ◽  
Surgical Intervention ◽  
Surgical Decompression ◽  
Foot Ulcers ◽  
Foot Surgery ◽  
Patients With Diabetes

Surgical intervention for chronic deformities and ulcerations has become an important component in the management of patients with diabetes mellitus. Such patients are no longer relegated to wearing cumbersome braces or footwear for deformities that might otherwise be easily corrected. Although surgical intervention in these often high-risk individuals is not without risk, the outcomes are fairly predictable when patients are properly selected and evaluated. In this brief review, we discuss the rationale and indications for diabetic foot surgery, focusing on the surgical decompression of deformities that frequently lead to foot ulcers. (J Am Podiatr Med Assoc 100(5): 369–384, 2010)

scholarly journals The Influence of Diabetic Foot Exercise in Sensory Peripheral Neuropathy with Monofilament Test on Diabetes Mellitus Clients

Jurnal NERS ◽  
2020 ◽  
Vol 14 (3) ◽  
pp. 340
Author(s):  
Tintin Sukartini ◽  
Candra Panji Asmoro ◽  
Nandani Alifah
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Neuropathy ◽  
Treatment Group ◽  
Diabetic Foot ◽  
Rank Test ◽  
Control Group ◽  
Sensory Peripheral Neuropathy ◽  
Signed Rank ◽  
Wilcoxon Signed Rank Test ◽  
Signed Rank Test

Background: Peripheral neuropathy is a long-term complication that attacks the nerves and loses the sensation of protection which affects about 50% of people with diabetes mellitus (DM). Diabetic foot exercises can help blood circulation, especially in the legs or lower limbs. This researched aimed to analyze the effect of diabetic foot exercise on sensory peripheral neuropathy in DM clients.Method: The study design used quasi-experimental pre-post test with control group. Samples were 28 respondents using purposive sampling and divided into two groups of 14 respondents each. The independent variable is diabetic foot training, and the dependent variable is peripheral sensory neuropathy. Interventions are carried out 3 times a week for 4 weeks. The research instrument was Weinstein Monofilament 10 g Semmes and a diabetic foot training checklist. Data analysis using the Wilcoxon-signed rank test and Mann Whitney test with α≤0.05.Result: The Wilcoxon-signed rank test in the treatment group showed differences in sensory peripheral neuropathy after treatment (p=0,000) and no difference in the control group (p=0.564). The Mann Whitney test results showed differences in sensory peripheral neuropathy between the treatment group and the control group after treatment p=0.039.Conclusion: Diabetic foot exercises can be used as an alternative measure to improve sensory peripheral neuropathy.

Effect of Different Factors on Glycosylated Hemoglobin (HbA1c) Levels Among Diabetes Mellitus Patients

2021 ◽  
Vol 15 (12) ◽  
pp. 3513-3515
Author(s):  
Bader Alsuwayt
Keyword(s):  
Diabetes Mellitus ◽  
Glycated Hemoglobin ◽  
Glycosylated Hemoglobin ◽  
Diabetic Patients ◽  
Study Results ◽  
Patients With Diabetes ◽  
Insulin Use ◽  
Low Rate ◽  
Statin Use ◽  
Hba1c Levels

Aim: To describe the rate of the controlled level of glycosylated hemoglobin (HbA1c) among diabetes mellitus patients in Dammam city, Kingdom of Saudi Arabia (KSA). To assess the association between the status of HbA1c and the different patient-related factors namely: insulin use, metformin, dyslipidemia, and statin use. Methods: This cross-sectional study was performed at Security Forces Hospital, Dammam, KSA, between November 2020 and February 2021. A sample of two hundred known diabetic patients who were regularly followed up at the outpatient department (OPD) was selected randomly for the current study. Results: A very low rate (24%) of controlled HbA1C levels in patients with diabetes (type 1 DM and type 2 DM), The data showed that 85 % of all participants in our study are T2DM patients, while only 15% are T1DM patients, Our data showed that patients with dyslipidemia, hypothyroidism, or hypertension have a high level of uncontrolled HbA1C levels. Surprisingly, both dyslipidemia and statin use were predictors of uncontrolled HbA1C, Unexpectedly, non-metformin use has a protective effect toward controlling HbA1C, While insulin use is a strong predictor of uncontrolled HbA1C (OD 5.20). Conclusion: A low rate of controlled glycated hemoglobin (HbA1c) level among patients with diabetes (T1DM and T2DM) in our sample urges the need for immediate intervention to investigate and improve the current findings. Further investigations are needed to fully explain the high rate of uncontrolled HbA1c among insulin, metformin and statins users. Keywords: Glycated hemoglobin, HbA1c, Diabetes mellitus, Statins, Metformin.

INTERRELATION OF HEMORHEOLOGICAL PARAMETERS WITH GLUCOSE AND GLYCATED HEMOGLOBIN IN PATIENTS WITH DIABETES MELLITUS TYPE2

2018 ◽  
Author(s):  
А.В. Муравьев ◽  
И.А. Тихомирова ◽  
С.В. Булаева ◽  
Ю.В. Малышева ◽  
А.В. Замышляев
Keyword(s):  
Diabetes Mellitus ◽  
Glycated Hemoglobin ◽  
Healthy Individuals ◽  
Glucose Content ◽  
Metabolic Hormones ◽  
Metabolism Regulation ◽  
Patients With Diabetes ◽  
Glycated Hemoglobin Level ◽  
Blood Transport

Введение. Нарушения реологических свойств крови при сахарном диабете 2 типа (СД-2) может приводить к снижению микрососудистой перфузии. Основной механизм, вероятно, связан с ухудшением микрореологии эритроцитов, в том числе из-за высокого содержания глюкозы и гликозилирования белков мембран клеток. Цель исследования: провести анализ связи гемореологических характеристик цельной крови и эритроцитов с содержанием глюкозы и гликированного гемоглобина и выявить влияние ряда метаболических гормонов на микрореологию эритроцитов у больных СД-2. Материалы и методы. У 30 больных СД-2 регистрировали параметры гемореологического профиля. Наряду с измерениями вязкости, деформируемости эритроцитов (ДЭ) и их агрегации (АЭ) определяли содержание глюкозы, гликированного гемоглобина и белков плазмы (альбуминов, глобулинов, фибриногена). В in vitro исследованиях регистрировали микрореологические характеристики эритроцитов после их инкубации с глюкозой и рядом метаболических гормонов (инсулином, глюкагоном, адреналином). Результаты. Наиболее существенные отличия гемореологических профилей у больных СД-2 от данных здоровых лиц были в их микрореологической части. Значения глюкозы и гликированного гемоглобина более выражено коррелировали с показателями гемореологического профиля у больных СД-2, чем у здоровых лиц: коэффициент корреляции между АЭ и концентраций глюкозы у больных СД-2 составил 0,660, в контрольной группе — 0,480. Под влиянием инсулина ДЭ достоверно повышалась, а АЭ, напротив, снижалась (p < 0,05). При инкубации эритроцитов с глюкагоном у больных СД-2 и у здоровых лиц АЭ была снижена на сходную величину. Адреналин в трех концентрациях умеренно повышал ДЭ (p < 0,05), а наблюдавшийся прирост АЭ был наибольшим при низкой концентрации гормона (0,01 мкМ). Заключение. Анализ параметров гемореологического профиля у больных СД-2 свидетельствует о нарушениях текучести крови и снижении ее транспортных возможностей. Также было показано, что гормоны, участвующие в регуляции метаболизма, оказывают прямое воздействие на микрореологию эритроцитов. Introduction. Disorders of blood rheological properties in diabetes mellitus type 2 (DM-2) can lead to reduction of microvascular perfusion. The main mechanism is probably associated with impairment of erythrocytes microrheology and also due to high glucose content and glycosylation of cell membrane proteins. Aim: to analyze the relationship between hemorheological characteristics of whole blood and erythrocytes with glucose content and glycated hemoglobin level, and to reveal the infl uence of metabolic hormones on erythrocytes microrheology in patients with DM-2. Materials and methods. In 30 patients with DM-2 we determined hemorheological parameters, blood viscosity, erythrocytes deformability (ED), erythrocytes aggregation (EA), glucose and glycated hemoglobin content, plasma proteins (albumins, globulins, fibrinogen) levels. In in vitro studies we recorded the microrheological characteristics of erythrocytes after their incubation with glucose and with some metabolic hormones (insulin, glucagon, adrenaline). Results. Microrheological parameters in patients with DM-2 diff ered signifi cantly from the parameters in healthy individuals. Glucose and glycated hemoglobin values more evidently correlated with hemorheological parameters in patients with DM-2 than in healthy individuals: the correlation coeffi cient between EA and glucose concentration in patients with DM-2 was 0.660, in healthy individuals — 0.480. Under insulin stimulus ED signifi cantly increased and AE, on contrary, decreased (p < 0.05). During erythrocytes incubation with glucagon EA similar reduced in patients with DM-2 and in healthy individuals. Adrenaline in three concentrations moderately increased ED (p < 0.05), and the observed EA increasing was greatest at low hormone concentration (0.01 μM). Conclusion. Analysis of hemorheological parameters in patients with DM-2 showed disorders of blood fl uidity and decreasing of blood transport capacity. It was also shown that hormones involved in metabolism regulation had a direct effect on erythrocytes microrheology.

Improved Sensitivity in Patients with Peripheral Neuropathy

2005 ◽  
Vol 95 (2) ◽  
pp. 143-147 ◽  
Author(s):  
Salvatore L. DeLellis ◽  
Dale H. Carnegie ◽  
Thomas J. Burke
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Peripheral Neuropathy ◽  
Diabetic Foot ◽  
Medical Records ◽  
Significant Clinical Improvement ◽  
The Mean ◽  
Protective Sensation ◽  
Loss Of Protective Sensation ◽  
Foot Sensation

The medical records of 1,047 patients (mean age, 73 years) with established peripheral neuropathy were examined to determine whether treatment with monochromatic infrared photo energy was associated with increased foot sensitivity to the 5.07 Semmes-Weinstein monofilament. The peripheral neuropathy in 790 of these patients (75%) was due to diabetes mellitus. Before treatment with monochromatic infrared photo energy, of the ten tested sites (five on each foot), a mean ± SD of 7.9 ± 2.4 sites were insensitive to the 5.07 Semmes-Weinstein monofilament, and 1,033 patients exhibited loss of protective sensation. After treatment, the mean ± SD number of insensate sites on both feet was 2.3 ± 2.4, an improvement of 71%. Only 453 of 1,033 patients (43.9%) continued to have loss of protective sensation after treatment. Therefore, monochromatic infrared photo energy treatment seems to be associated with significant clinical improvement in foot sensation in patients, primarily Medicare aged, with peripheral neuropathy. Because insensitivity to the 5.07 Semmes-Weinstein monofilament has been reported to be a major risk factor for diabetic foot wounds, the use of monochromatic infrared photo energy may be associated with a reduced incidence of diabetic foot wounds and amputations. (J Am Podiatr Med Assoc 95(2): 143–147, 2005)

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