Antioxidant and oxidative stress status in type 2 diabetes and diabetic foot ulcer

Sarcopenia is an independent risk factor for all-cause mortality rate in patients with diabetic foot ulcers

Objective

This study aimed to determine whether sarcopenia affects the all-cause mortality rate of patients with diabetic foot ulcers (DFUs).

Research design and methods

The clinic-based observational study included 217 patients treated at the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University during a 4-year period. All subjects underwent dual-energy X-ray absorptiometry to determine their body composition during hospitalization. Diagnosis of sarcopenia was based on the Baumgartner diagnostic criteria. Patients were followed up regularly by phone calls until April 1, 2019, and their survival status was recorded.Univariate and multivariate Cox risk ratio regression models were used to analyze factors influencing the all-cause mortality rate of patients with DFUs.

Results

Of the 217 patients, 158 people survived (82.7%), 33 died (17.3%), and 26 were lost to follow-up. The median follow-up time was 23 (Range 11-34) months. The majority of patients were male (68.6%), with a mean age of 67.29 ± 11.14 years. The 5-year survival rate was 68.3% and 45.9% for all study patients (n = 217) and sarcopenia patients (n = 81), respectively. Multivariate Cox risk regression model showed that age (HR 1.042[95%CI:1.006, 1.078], P = 0.021), sarcopenia (HR 5.051[95%CI:1.968, 12.961], P = 0.001), and serum creatinine (HR 1.007[95%CI: 1.003, 1.010], P < 0.001) were independent risk factors for all-cause mortality rate of patients with DFUs. Kaplan-Meier survival curve indicated that the survival rate of patients with sarcopenia was significantly lower than non-sarcopenia patients (P < 0.001).

Conclusions

Sarcopenia is an independent risk factor for all-cause mortality of patients with DFUs and hence an important prognostic factor for patients with DFUs. Active prevention and improvement of sarcopenia can potentially improve the survival outcomes of this patient population.

Biomarkers of dyslipidemia in patients with diabetic foot

Diabetic foot (DF) is one of the most severe complications of diabetes that significantly reduces the quality of life and survival of patients. Besides firmly established risk factors, novel data indicate that alterations in lipid metabolism might also be implicated in the development and progression of DF. Diabetic dyslipidemia is characterized by the atherogenic triad, consisting of increased triglycerides (TG), decreased high-density lipoprotein cholesterol (HDL-C) levels and the presence of small, dense low-density lipoprotein (LDL) particles. Accumulating evidence suggests that profound hypertriglyceridemia and HDL-C reduction are common findings in patients with diabetic neuropathy and significantly contribute to an increased risk for DF, amputation and mortality. Small, dense LDL particles play an important role in the development of cardiovascular complications of diabetes, but their clinical importance in patients with DF remains to be established. In this paper, we will discuss the significance of standard and novel lipid biomarker determination in the assessment of the risk for the development and progression of DF.

Efficacy of comprehensive ozone therapy in diabetic foot ulcer healing

BACKGROUND

Diabetic foot ulcer is one of the common complications of diabetes disease that is costly and difficult to treat. This problem can lead to morbidity and even mortality. Ozone is a gas that can optimize cellular metabolism and, because of its antioxidant and antibacterial effects, can help the better healing of diabetic foot ulcer.

METHOD

Two hundred patients, aged 18-85 with diabetic foot ulcers ranging from grade 1 to 4 according to Wagner classification in two groups were studied. Group 1 was treated by full ozone therapy besides the standard regular DFU treatment while group two just was received routine diabetic foot care. Wound size, wound grade, healing time, Fasting blood sugar and inflammatory biomarker before and after treatment were checked.

RESULTS

All patients have had complete wound closure in the ozone group. The mean age of the patients included in the results was 59.03 ± 12.593 and 53.5 ± 10.212 for ozone group and control group. The baseline average surface area of ulcers was 13.41 ± 14.092 cm² (range 1-70 cm²) in ozone group and 12.72 ± 0.911 (range 1_64 cm²) in the control group. Average healing time was 69.44 ± 36.055 days (range 15-180 days), which is significantly lower than the median healing time measured in the control group and some previous studies.

CONCLUSION

Our study results support the efficacy of ozone therapy especially in its comprehensive use in DFU healing and reduction in the chances of infection and amputation.