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Ashoobi MT, Hemmati H, Moayerifar M, Moayerifar M, Gholipour M, Motiei M, Yazdanipour MA, Eslami Kenarsari H. The role of diabetic foot treatment in improving left ventricular function: Insights from global longitudinal strain echocardiography. PLoS One 2024; 19:e0299887. [PMID: 38551943 PMCID: PMC10980188 DOI: 10.1371/journal.pone.0299887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/16/2024] [Indexed: 04/01/2024] Open
Abstract
We decided to evaluate the effect of treatment of diabetic foot ulcers in improving heart function by strain echocardiography than conventional transthoracic echocardiography. This prospective cross-sectional study included patients with diabetic foot ulcer (DFU). Conventional and two-dimensional strain echocardiography performed before and after three months diabetic foot treatment. Then, we compared the echocardiographic parameters including left ventricular ejection fraction (LV-EF), left ventricular global longitudinal strain (LV-GLS). Multivariate and univariate logistic regression analysis were performed to find which variable was mainly associated with LV-GLS changes. 62 patients with DFU were conducted. After echocardiography, all patients underwent surgical or non-surgical treatments. Three months after the treatment, LV-EF was not significantly different with its' primary values (P = 0.250), but LV-GLS became significantly different (P<0.05). In the multivariate logistic regression analysis, with the increase in the grade of ulcer, LV-GLS improved by 6.3 times. Not only the treatment of DFU helps to control adverse outcomes like infection, limb loss and morbidity but also it enhances cardiac function. Of note, strain echocardiography found to be a better indicator of myocardial dysfunction than LV-EF. These findings make a strong reason for the routine assessment of cardiac function in patients with DFU.
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Affiliation(s)
- Mohammad Taghi Ashoobi
- Department of Vascular Surgery, Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Hosein Hemmati
- Department of Vascular Surgery, Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Maziar Moayerifar
- Department of Vascular Surgery, Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mani Moayerifar
- Department of Vascular Surgery, Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahboobeh Gholipour
- Department of Cardiology, Healthy Heart Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahsa Motiei
- School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Ali Yazdanipour
- Neuroscience Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran
| | - Habib Eslami Kenarsari
- Vice-Chancellorship of Research and Technology, Guilan University of Medical Science, Rasht, Iran
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Maiya GA, Nataraj M, K G, Hande M, Rodrigues GS, Shenoy R, Prasad SS. KADAM topical warm oxygen therapy device for diabetic foot ulcer-a novel approach. J Diabetes Metab Disord 2023; 22:507-514. [PMID: 37255791 PMCID: PMC10225447 DOI: 10.1007/s40200-022-01172-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/12/2022] [Indexed: 06/01/2023]
Abstract
Purpose Diabetic foot ulcer (DFU) is a significant healthcare burden demanding prompt attention. In the past decade, newer technologies such as topical oxygen therapy have grown increasingly popular. The purpose of the study was to determine effect of KADAM-a topical warm oxygen therapy (TWOT) medical device in healing of DFU. Methods The KADAM medical device developed by Yostra Labs Pvt Ltd, delivered pure oxygen between 93 ± 3% concentration at an optimal temperature range of 39-42º Celsius to DFU wound site. Results A total of 40 diabetic foot ulcer individuals, aged over 18 years were included in the study. Individuals with the Grade 1 DFU were 34 (85%), grade 2 were 5 (12.5%) and grade 3 were 1 (2.5%). The changes in initial area and final area for the various diabetic foot ulcer grades were as follows: 0.32 [0.12, 0.96] (< 0.001) for grade 1 ulcer, 0.76 [0.54, 1.17] (P = 0.013) for grade 2 ulcer and 1.26 for grade 3 ulcer. The percentage reduction in wound size achieved for the grade 1 & 2 DFU were 100%, and grade 3 was 75%. Conclusion Topical warm oxygen therapy serves as an adjunctive modality to facilitate diabetic foot ulcer healing in the clinical practice.
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Affiliation(s)
- G. Arun Maiya
- Department of Physiotherapy, Centre for Diabetic Foot Care & Research (CDFCR), Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Manipal, 576104 Karnataka India
| | - Megha Nataraj
- Department of Physiotherapy, Centre for Diabetic Foot Care & Research (CDFCR), Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Manipal, 576104 Karnataka India
| | - Gagana K
- Department of Physiotherapy, Centre for Diabetic Foot Care & Research (CDFCR), Manipal College of Health Professions (MCHP), Manipal Academy of Higher Education (MAHE), Manipal, 576104 Karnataka India
| | - Manjunatha Hande
- Department of Medicine, Kasturba Medical College-Manipal, Manipal Academy of Higher Education (MAHE), Manipal, 576104 Karnataka India
| | - Gabriel Sunil Rodrigues
- Department of Surgery, Kasturba Medical College-Manipal, Manipal Academy of Higher Education (MAHE), Manipal, 576104 Karnataka India
| | - Rajgopal Shenoy
- Department of Surgery, Kasturba Medical College-Manipal, Manipal Academy of Higher Education (MAHE), Manipal, 576104 Karnataka India
| | - Shiva S. Prasad
- Department of Surgery, Kasturba Medical College-Manipal, Manipal Academy of Higher Education (MAHE), Manipal, 576104 Karnataka India
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Mizrak HI, Hansen TW, Andersen JA, Rossing P, Rasmussen A, Hansen CS. Distal symmetrical polyneuropathy is present in all individuals with diabetes and foot ulcers - and does not associate with healing time. J Diabetes Complications 2022; 36:108353. [PMID: 36370668 DOI: 10.1016/j.jdiacomp.2022.108353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/13/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
We estimated the occurrence of diabetic neuropathy using six different diagnostic modalities in individuals with newly diagnosed diabetic foot ulcers (DFUs) and assessed the association with DFU healing time. All individuals with DFU had distal symmetrical polyneuropathy. Presence of neuropathy did not associate with ulcer healing time (p ≥ 0.12).
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Affiliation(s)
| | | | - Jonas Askø Andersen
- Steno Diabetes Center Copenhagen, Denmark; Orthopedic Department, North Zealand Hospital, Hillerød Hospital, Denmark
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Tong KP, Intine R, Wu S. Vitamin C and the management of diabetic foot ulcers: a literature review. J Wound Care 2022; 31:S33-S44. [PMID: 36113854 DOI: 10.12968/jowc.2022.31.sup9.s33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The lifetime risk of developing a diabetic foot ulcer (DFU) in people with diabetes is as high as 25%. A trio of factors constitute the diabetic foot syndrome that characterises DFUs, including neuropathy, vascular disease and infections. Vitamin C has important functions in the nervous, cardiovascular, and immune systems that are implicated in DFU development. Furthermore, vitamin C deficiency has been observed in individuals with DFUs, suggesting an important function of vitamin C in DFU management and treatment. Therefore, this literature review evaluates the role of vitamin C in the nervous, cardiovascular and immune systems in relation to wound healing and DFUs, as well as discussing vitamin C's lesser known role in depression, a condition that affects many individuals with a DFU. METHOD A literature search was done using PubMed, Cochrane Library, Embase, Ovid, Computer Retrieval of Information on Scientific Projects, and NIH Clinical Center. Search terms included 'diabetic foot ulcer,' 'diabetic foot,' 'vitamin C,' and 'ascorbic acid.' RESULTS Of the 71 studies initially identified, seven studies met the inclusion criteria, and only three were human clinical trials. Overall, the literature on this subject is limited, with mainly observational and animal studies, and few human clinical trials. CONCLUSION There is a need for additional human clinical trials on vitamin C supplementation in individuals with a DFU to fill the knowledge gap and guide clinical practice.
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Affiliation(s)
- Khanh Phuong Tong
- Dr William M Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, Illinois, US
| | - Robert Intine
- School of Graduate and Postdoctoral Studies, College of Health Professions, Rosalind Franklin University of Medicine and Science, Illinois, US
| | - Stephanie Wu
- Dr William M Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, Illinois, US
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Diabetic Foot Ulcers and Cardiac Autonomic Neuropathy. Clin Ther 2021; 44:323-330. [PMID: 34974945 DOI: 10.1016/j.clinthera.2021.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/21/2021] [Accepted: 12/08/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Diabetic foot ulcers (DFUs) and cardiac autonomic neuropathy (CAN) are severe complications of diabetes mellitus (DM). Both DFU and CAN are associated with increased risk of major cardiovascular events and mortality. Because of the clinical impact of both these conditions, it is important to establish what effect the presence of CAN has on DFU outcomes. METHODS This is a narrative review of original research articles identified through an electronic search of PubMed, Scopus, and Google scholar databases until June 2021 exploring CAN in individuals with DFUs. We explored prevalence, patient outcomes (DFU healing and amputation), and mortality. FINDINGS Evidence suggests that the prevalence of CAN is high, ranging from 43% to 66% among those with DFUs. The presence of CAN may also increase the odds of developing DFUs. A single-center, prospective, observational study has suggested that the presence of CAN significantly reduces DFU healing time. The impact on amputation is indeterminate, with conflicting reports from studies reporting either no or increased risk. On the basis of limited evidence, CAN may be associated with increased mortality in individuals with DFUs. IMPLICATIONS The interplay between CAN and DFUs is poorly understood from current literature. Given the high prevalence of CAN in individuals with DFUs and the potential for suboptimal outcomes, further high-quality studies are required to determine future management approaches when both conditions coexist and to establish whether early CAN screening in individuals with diabetes at high risk of foot ulceration may ultimately improve their outlook.
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Rubio JA, Jiménez S, Lázaro-Martínez JL. Mortality in Patients with Diabetic Foot Ulcers: Causes, Risk Factors, and Their Association with Evolution and Severity of Ulcer. J Clin Med 2020; 9:jcm9093009. [PMID: 32961974 PMCID: PMC7565534 DOI: 10.3390/jcm9093009] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/08/2020] [Accepted: 09/14/2020] [Indexed: 12/17/2022] Open
Abstract
Background: This study reviews the mortality of patients with diabetic foot ulcers (DFU) from the first consultation with a Multidisciplinary Diabetic Foot Team (MDFT) and analyzes the main cause of death, as well as the relevant clinical factors associated with survival. Methods: Data of 338 consecutive patients referred to the MDFT center for a new DFU during the 2008–2014 period were analyzed. Follow-up: until death or until 30 April 2020, for up to 12.2 years. Results: Clinical characteristics: median age was 71 years, 92.9% had type 2 diabetes, and about 50% had micro-macrovascular complications. Ulcer characteristics: Wagner grade 1–2 (82.3%), ischemic (49.2%), and infected ulcers (56.2%). During follow-up, 201 patients died (59.5%), 110 (54.7%) due to cardiovascular disease. Kaplan—Meier curves estimated a reduction in survival of 60% with a 95% confidence interval (95% CI), (54.7–65.3) at 5 years. Cox regression analysis adjusted to a multivariate model showed the following associations with mortality, with hazard ratios (HRs) (95% CI): age, 1.07 (1.05–1.08); HbA1c value < 7% (53 mmol/mol), 1.43 (1.02–2.0); active smoking, 1.59 (1.02–2.47); ischemic heart or cerebrovascular disease, 1.55 (1.15–2.11); chronic kidney disease, 1.86 (1.37–2.53); and ulcer severity (SINBAD system) 1.12 (1.02–1.26). Conclusion: Patients with a history of DFU have high mortality. Two less known predictors of mortality were identified: HbA1c value < 7% (53 mmol/mol) and ulcer severity.
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Affiliation(s)
- José Antonio Rubio
- Diabetic Foot Unit, Department of Endocrinology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, 28805 Madrid, Spain;
- Department of Biomedical Sciences, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain
- Correspondence: ; Tel.: +34-918-878-100
| | - Sara Jiménez
- Diabetic Foot Unit, Department of Endocrinology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, 28805 Madrid, Spain;
| | - José Luis Lázaro-Martínez
- Diabetic Foot Unit, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain;
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Farrow F, Fountoulakis N, Cummins K, Sharma A, Mahmood R, Vas P, Thomas S, Karalliedde J. Cardiac Autonomic Neuropathy is Associated with Improved Diabetic Foot Ulcer Healing: A Single Centre Prospective Cohort Study. Exp Clin Endocrinol Diabetes 2020; 129:895-898. [PMID: 32615612 DOI: 10.1055/a-1158-9130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS People with diabetes and peripheral neuropathy (DPN) are at high risk of diabetic foot ulceration (DFU). The prevalence of cardiac autonomic neuropathy (CAN) in people with DFU is unknown and if CAN influences DFU healing is unclear. METHODS We investigated, in a prospective observational single-centre cohort study, if CAN predicts DFU healing in 47 (77% male) people with a DFU and DPN attending a university hospital foot clinic. CAN was diagnosed by 2 or more abnormal Ewing's tests. Baseline DFU severity was evaluated using the site, ischaemia, neuropathy, bacterial infection, area and depth (SINBAD) score. The primary outcome was defined as evidence of DFU healing on clinical examination. Median (interquartile) length of follow-up was 1150 (624-1331) days. RESULTS The prevalence of CAN was 43%. Of the cohort, 70% had complete healing of their DFU. Participants with CAN had a shorter median (interquartile) duration time to heal compared to those without CAN [91 (44-164) days compared to 302 (135-413) (p=0.047)]. Minor/major amputation and mortality was similar in both groups. The presence of CAN increased DFU healing by two-fold [HR=2.05, 95% CI 1.01-4.16, p=0.046] in multivariable competing risk analyses. CONCLUSIONS We demonstrate a high prevalence of CAN in a DFU cohort and that CAN is associated with improved DFU healing. The results of this study establish the scientific rationale for further studies to better understand the mechanisms between CAN and DFU outcomes.
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Affiliation(s)
- Frederick Farrow
- School of Cardiovascular Medicine & Sciences, King's College London, London, United Kingdom
| | - Nikolaos Fountoulakis
- School of Cardiovascular Medicine & Sciences, King's College London, London, United Kingdom
| | - Kelly Cummins
- School of Cardiovascular Medicine & Sciences, King's College London, London, United Kingdom
| | - Angelica Sharma
- School of Cardiovascular Medicine & Sciences, King's College London, London, United Kingdom
| | - Rabiah Mahmood
- School of Cardiovascular Medicine & Sciences, King's College London, London, United Kingdom
| | - Prashanth Vas
- School of Cardiovascular Medicine & Sciences, King's College London, London, United Kingdom
| | - Stephen Thomas
- School of Cardiovascular Medicine & Sciences, King's College London, London, United Kingdom
| | - Janaka Karalliedde
- School of Cardiovascular Medicine & Sciences, King's College London, London, United Kingdom
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Gmitrov J. Static Magnetic Field Versus Systemic Calcium Channel Blockade Effect on Microcirculation: Possible Mechanisms and Clinical Implementation. Bioelectromagnetics 2020; 41:447-457. [DOI: 10.1002/bem.22272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/03/2020] [Accepted: 05/18/2020] [Indexed: 01/13/2023]
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Pang M, Zhu M, Lei X, Chen C, Yao Z, Cheng B. Changes in Foot Skin Microbiome of Patients with Diabetes Mellitus Using High-Throughput 16S rRNA Gene Sequencing: A Case Control Study from a Single Center. Med Sci Monit 2020; 26:e921440. [PMID: 32358479 PMCID: PMC7212808 DOI: 10.12659/msm.921440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Worldwide, the treatment of complications associated with type 2 diabetes mellitus, including diabetic foot ulcer (DFU), results in an economic burden for patients and healthcare systems. This study aimed to use high-throughput 16S rRNA gene sequencing to investigate the changes in foot skin microbiome of patients with diabetes mellitus from a single center in China. Material/Methods Fifty-two participants were divided into 4 study groups: healthy controls (n=13); patients with short-term diabetes (<2 years; n=13); patients with intermediate-term diabetes (5–8 years; n=13); and patients with long-term diabetes (>10 years; n=13). Swabs were analyzed from the intact skin of the foot arch using high-throughput 16S ribosomal RNA sequencing. Results Microbiome phylogenic diversity varied significantly between the study groups (whole tree, P<0.01; Chao1, P<0.01), but were similar within the same group. The findings were supported by non-parametric multidimensional scaling (stress=0.12) and principal component analysis (principal component 1, 8.38%; principal component 2, 5.28%). In patients with diabetes mellitus, the dominant skin microbial phyla were Firmicutes, Proteobacteria, Actinobacteria, and Bacteroidetes. Conclusions High-throughput 16S rRNA gene sequencing showed dynamic changes in the skin microbiome from the foot during the progression of diabetes mellitus. These findings support the importance of understanding the role of the skin microbiota in the pathogenesis of DFU.
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Affiliation(s)
- Mengru Pang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command, People's Liberation Army (PLA), Guangzhou, Guangdong, China (mainland)
| | - Meishu Zhu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Department of Burn and Plastic Surgery, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China (mainland).,Department of Burn and Plastic Surgery, The Second People's Hospital of Shenzhen, Shenzhen, Guangdong, China (mainland)
| | - Xiaoxuan Lei
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command, People's Liberation Army (PLA), Guangzhou, Guangdong, China (mainland)
| | - Caihong Chen
- Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command, People's Liberation Army (PLA), Guangzhou, Guangdong, China (mainland).,Guangdong Pharmaceutical University, Guangzhou, Guangdong, China (mainland)
| | - Zexin Yao
- Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command, People's Liberation Army (PLA), Guangzhou, Guangdong, China (mainland).,Guangdong Pharmaceutical University, Guangzhou, Guangdong, China (mainland)
| | - Biao Cheng
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command, People's Liberation Army (PLA), Guangzhou, Guangdong, China (mainland).,Center of Wound Treatment, General Hospital of Southern Theater Command, People's Liberation Army (PLA), Guangzhou, Guangdong, China (mainland).,The Key Laboratory of Trauma Treatment and Tissue Repair of Tropical Area, General Hospital of Southern Theater Command, People's Liberation Army (PLA), Guangzhou, Guangdong, China (mainland)
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Ghobadi A, Ahmadi Sarbarzeh P, Jalilian M, Abdi A, Manouchehri S. Evaluation of Factors Affecting the Severity of Diabetic Foot Ulcer in Patients with Diabetes Referred to a Diabetes Centre in Kermanshah. Diabetes Metab Syndr Obes 2020; 13:693-703. [PMID: 32214832 PMCID: PMC7078779 DOI: 10.2147/dmso.s242431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/02/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Diabetes mellitus is a metabolic disease characterized by high blood sugar (BS) levels and the change in the metabolism of lipids, carbohydrates, and insulin resistance, and is one of the main causes of disability and mortality worldwide. Among the different types of complications, which have many negative effects on personal and social life, diabetic foot ulcer (DFU) is very important. This study aims to investigate the factors affecting the severity of DFU among patients with diabetes. METHODS The study participants included 190 diabetic patients with a diagnosis of DFU. Data were collected using a two-part questionnaire for self-care awareness and functions in diabetic patients and Wagner's scale. The questionnaire was answered in cooperation with patients and the Wagner's score was estimated by a wound supervisor in the diabetes center. RESULTS There was 109 women (57.4%). Twenty-six patients had other diabetic complications as well as DFU. The average score of awareness in patients was 6.99±2.76 and the function was 62.22±9.92. The results found a direct relation between the age and the duration of illness with the score of the patient's awareness (P=0.008, P=0.000). There was also a direct relation between the level of education with score of awareness and the score of function in self-care (P=0.000, P=0.000), but the statistical results did not find any relation between awareness and the function in self-care of patients with the severity of DFU (P>0.05). DISCUSSION There was no relation between the self-care awareness and function with severity of DFU (P>0.05) that can be due to the more relation between DFU severity with hygiene and physical factors after the disease and the effect of awareness and function would be only in the incidence of the DFU. CONCLUSION Awareness and function of patients in self-care is less than average. Increasing awareness of patients and empowering them through appropriate training can be effective in preventing diabetic foot ulcers.
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Affiliation(s)
- Akram Ghobadi
- Nursing Department, Nursing and Midwifery School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Pegah Ahmadi Sarbarzeh
- Nursing Department, Nursing and Midwifery School, Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Milad Jalilian
- Nursing Department, Nursing and Midwifery School, Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- Nursing Department, Nursing and Midwifery School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sara Manouchehri
- Biostatistics Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Shareef AM, Ahmedani MY, Waris N. Strong association of anemia in people with diabetic foot ulcers (DFUs): Study from a specialist foot care center. Pak J Med Sci 2019; 35:1216-1220. [PMID: 31488981 PMCID: PMC6717462 DOI: 10.12669/pjms.35.5.1421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background & Objective Anemia is common finding in people with diabetes and diabetic foot ulcers. Therefore, our objective was to observe and compare the association of anemia in people with diabetic foot ulcers (DFUs) with age and sex matched people without DFUs. Method This prospective case control study was undertaken at a multidisciplinary diabetic foot clinic of Baqai Institute of Diabetology and Endocrinology (BIDE) between October 2014 and October 2015. Participants were categorized into two groups; Case group (people with DFUs) and Control group (people without DFUs). Baseline demographic characteristics, biochemical and hematological parameters were recorded. University of Texas (UT) classification system was used to grade and stage DFU in case group. Subjects with other apparent causes of anaemia were excluded. Age and sex matched controls were taken from diabetic clinic presented during same time period. Data was analyzed by using statistical package for social science (SPSS) version 20. Results Total of 161 participants in case group were compared with similar number of age and sex matched participants of control group. Most of the participants were males 119(73.9%). Age and sex matched case and control groups were comparable except for duration of diabetes, BMI and HDL levels. Overall, 85.67% case group (males 64.56%); females 21.11%) and 35.3% control group (males 22.9%; females12.4%) have anemia. Mean Hb level was 10.49g/dl in case group and 13.39g/dl in control group. Significant differences were also noted in other blood parameters. Conclusion Our study concludes that anaemia is strongly associated with DFU disease. Anaemia should be considered and treated as co-morbidity while managing patients with foot ulcers.
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Affiliation(s)
- Abdul Majid Shareef
- Dr. Abdul Majid Shareef, MBBS. Podiatric Surgeon, Department of Foot, Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University (BMU), Karachi-Pakistan
| | - Muhammad Yakoob Ahmedani
- Prof. Muhammad Yakoob Ahmedani, FCPS. Professor of Medicine (BMU), Department of Medicine, Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University (BMU), Karachi-Pakistan
| | - Nazish Waris
- Dr. Nazish Waris, Ph.D. Research Officer, Research Department, Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University (BMU), Karachi-Pakistan
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12
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Bokhari SRA, Inayat F, Jawa A, Virk HUH, Awais M, Hussain N, Hassan GU, Ahmad HI, Chaudhry HS, Adil A, Haider A, Figueredo VM, Rangaswami J, Assir MZK. Cardiovascular Autonomic Neuropathy and its Association with Cardiovascular and All-cause Mortality in Patients with End-stage Renal Disease. Cureus 2018; 10:e3243. [PMID: 30410849 PMCID: PMC6214649 DOI: 10.7759/cureus.3243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background End-stage renal disease frequently leads to increased cardiovascular mortality. Cardiovascular autonomic neuropathy (CAN) may be predictive of cardiac arrhythmias and sudden cardiac death in patients with end-stage renal disease. Methods A total of 70 patients with end-stage renal disease were included in the study. The assessment of cardiac dysautonomia was based on the four standardized tests performed at the baseline and, again, at the end of the study. The criteria for CAN included at least two abnormal test results. Results Fifty of 70 patients completed the study and were followed-up after one year. Out of the 50 patients, 44 (88%) had CAN at baseline. Twelve (24%) patients died at the one-year follow-up. Sudden cardiac death was reported in seven out of 12 (58%) patients. All seven patients who died had high dysautonomia scores (three abnormal tests) at the baseline. There was a significantly higher percentage of patients with all four abnormal tests amongst patients who died of any cause (56% vs. 17%; RR 6.07, 95% CI 1.29-28.49; p-value 0.02) or due to sudden cardiac death (43% vs. 10.5%; RR 6.37, 95% CI 1.03-39.36; p-value 0.04). All five patients who did not have CAN at the baseline developed this abnormality on repeat testing after one year. Conclusion The prevalence of CAN in patients with end-stage renal disease on maintenance hemodialysis was significantly higher. CAN was an independent predictor of all-cause and cardiovascular mortality, which highlights it as a risk stratification tool in patients with end-stage renal disease.
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Affiliation(s)
- Syed Rizwan A Bokhari
- Department of Nephrology and Hypertension, Tulane University School of Medicine, New Orleans, USA
| | - Faisal Inayat
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Ali Jawa
- Department of Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
| | - Hafeez Ul Hasan Virk
- Department of Cardiovascular Diseases, Einstein Heart and Vascular Institute, New York, USA
| | - Muhammad Awais
- Department of Medicine, Prince Sultan Military Medical City, Riyadh, SAU
| | - Nadeem Hussain
- Department of Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Ghias Ul Hassan
- Department of Medicine, Ameer Ud Din Medical College, Lahore, PAK
| | - Hafiz Ijaz Ahmad
- Department of Nephrology, Allama Iqbal Medical College, Lahore, PAK
| | - Hammad S Chaudhry
- Department of Medicine, Allama Iqbal Medical College/Jinnah Hospital, Lahore, PAK
| | - Abdullah Adil
- Depertment of Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Ali Haider
- Department of Medicine, Allama Iqbal Medical College, Jhang, PAK
| | - Vincent M Figueredo
- Department of Cardiovascular Diseases, Einstein Medical Center, Philadelphia, USA
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13
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Wang S, He Y, Xu L, Zhang S, Gu X, Gu J, Shi J, Shen Y, Tang Z. Association between QTc interval prolongation and outcomes of diabetic foot ulcers: Data from a 4-year follow-up study in China. Diabetes Res Clin Pract 2018; 138:26-34. [PMID: 29382590 DOI: 10.1016/j.diabres.2018.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/30/2017] [Accepted: 01/23/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To examine whether QTc interval prolongation is an independent risk factor of outcomes in patients with diabetic foot ulcers (DFU). RESEARCH DESIGN AND METHODS 331 patients with type 2 diabetes and DFU hospitalized in a Chinese tertiary hospital were recruited. ECG was done at baseline and QTc interval was calculated through Bazett's formula. Participants were classified into 2 groups according to the QTc interval as prolonged (≥440 ms) or not (<440 ms). These patients were followed-up for an average of 48 months to observe the outcomes, including ulcer healing, ulcer recurrence, nonfatal cerebral or cardiovascular events (NCCVE), cerebral cardiovascular death, cardiac death and all-cause death. The associations between the risk of outcomes and QTc interval prolongation, as well as per 1-SD increase in QTc interval were analyzed by Cox proportional-hazards models. RESULTS In terms of the univariate Cox proportional hazard models, patients with QTc interval prolongation had a higher all-cause mortality (HR = 1.621, 95%CI: 1.040-2.526, P = .013), higher cardiac mortality (HR = 2.011 95%CI: 1.106-3.657, P = .019), higher cerebral cardiovascular mortality (HR = 1.525, 95%CI: 0.8151-2.852, P = .045). The multivariate analysis showed that QTc prolongation was an independent risk factor for cardiac death (HR = 5.465, 95%CI: 2.818-8.112, P = .039). Similar results were obtained when QTc interval was used as a continue variable, a 1-SD increase in QTc interval was associated with an 5.883 times risk for cardiac mortality (HR = 6.883, 95%CI: 4.153-9.613, P = .012). The association between QTc interval prolongation with ulcer healing, recurrence and NCCVE were not observed either in univariate or multivariate analysis (P > .05). CONCLUSION QTc interval prolongation was a plausible predictor for cardiac death in DFU patients, but it cannot accurately predict ulcer healing or recurrence.
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Affiliation(s)
- Shumin Wang
- Shanghai Clinical Center for Endocrine and Metabolism Diseases, Yuanyang Subdivision for Diabetic Foot Disease, Shanghai Institute of Endocrine and Metabolism Disease, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Yang He
- Shanghai Clinical Center for Endocrine and Metabolism Diseases, Yuanyang Subdivision for Diabetic Foot Disease, Shanghai Institute of Endocrine and Metabolism Disease, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Lei Xu
- Shanghai Clinical Center for Endocrine and Metabolism Diseases, Yuanyang Subdivision for Diabetic Foot Disease, Shanghai Institute of Endocrine and Metabolism Disease, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Shanshan Zhang
- Shanghai Clinical Center for Endocrine and Metabolism Diseases, Yuanyang Subdivision for Diabetic Foot Disease, Shanghai Institute of Endocrine and Metabolism Disease, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Xueming Gu
- Department of Internal Medicine, Shanghai Yuanyang Hospital, Shanghai 200031, China
| | - Junyi Gu
- Department of Internal Medicine, Shanghai Yuanyang Hospital, Shanghai 200031, China
| | - Jianyuan Shi
- Department of Internal Medicine, Shanghai Yuanyang Hospital, Shanghai 200031, China
| | - Yaping Shen
- Department of Internal Medicine, Shanghai Yuanyang Hospital, Shanghai 200031, China
| | - Zhengyi Tang
- Shanghai Clinical Center for Endocrine and Metabolism Diseases, Yuanyang Subdivision for Diabetic Foot Disease, Shanghai Institute of Endocrine and Metabolism Disease, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200025, China; Department of Internal Medicine, Shanghai Yuanyang Hospital, Shanghai 200031, China.
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14
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Rubio JA, Jiménez S, Álvarez J. Clinical characteristics and mortality in patients treated in a Multidisciplinary Diabetic Foot Unit. ACTA ACUST UNITED AC 2017; 64:241-249. [PMID: 28495319 DOI: 10.1016/j.endinu.2017.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVE This study reviews the clinical characteristics of patients with diabetic foot ulcer treated in a Multidisciplinary Diabetic Foot Unit (MDFU) and analyzes the mortality and factors associated with its survival. MATERIAL AND METHODS Data from all patients who attended the MDFU for the first time for a diabetic foot ulcer during the 2008-2014 period were analized. The patients were followed until their death or until June 30, 2016, for up to 8 years. RESULTS A total of 345 patients were included, with a median age (P25-P75) of 71 (61.5-80) years, and 321 (93%) had type 2 diabetes. They were characterized as patients with inadequate glycemic control, 48% had HbA1c ≥ 8% and high prevalence of chronic complications: 60.2% retinopathy, 43.8% nephropathy and 47.2% ischemic heart disease and/or cerebrovascular disease. A total of 126 (36.5%) patients died and 69 (54.8%) were due to cardiovascular disease. Survival measured by Kaplan-Meier declined over time to 69, 60 and 45% at 3, 5 and 7 years respectively. Cox's multivariate regression analysis showed the following variables associated with mortality, HR (95% CI): age 1.08 (1.05-1.11); previous amputation 2.24 (1.34-3.73); active smoking 2.10 (1.12-3.97); cerebrovascular disease 1.75 (1.05-2.92); renal dysfunction 1.65 (1.04-2.61) and ischemic heart disease 1.60 (1.01-2.51). CONCLUSIONS Patients with diabetic foot ulcer are characterized by high morbidity and mortality, with cardiovascular disease being the most frequent cause of death. It is necessary to pay more attention to this risk group, tailoring objectives and treatments to their situation and life expectancy.
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Affiliation(s)
- José Antonio Rubio
- Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; Departamento de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; Departamento de Ciencias Biomédicas, Universidad de Alcalá, Alcalá de Henares, España.
| | - Sara Jiménez
- Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; Departamento de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España
| | - Julia Álvarez
- Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; Departamento de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Alcalá de Henares, España
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15
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Lange-Maia BS, Newman AB, Jakicic JM, Cauley JA, Boudreau RM, Schwartz AV, Simonsick EM, Satterfield S, Vinik AI, Zivkovic S, Harris TB, Strotmeyer ES. Relationship between sensorimotor peripheral nerve function and indicators of cardiovascular autonomic function in older adults from the Health, Aging and Body Composition Study. Exp Gerontol 2017; 96:38-45. [PMID: 28442382 DOI: 10.1016/j.exger.2017.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 04/06/2017] [Accepted: 04/18/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Age-related peripheral nervous system (PNS) impairments are highly prevalent in older adults. Although sensorimotor and cardiovascular autonomic function have been shown to be related in persons with diabetes, the nature of the relationship in general community-dwelling older adult populations is unknown. METHODS Health, Aging and Body Composition participants (n=2399, age=76.5±2.9years, 52% women, 38% black) underwent peripheral nerve testing at the 2000/01 clinic visit. Nerve conduction amplitude and velocity were measured at the peroneal motor nerve. Sensory nerve function was assessed with vibration detection threshold and monofilament (1.4-g/10-g) testing at the big toe. Symptoms of lower-extremity peripheral neuropathy were collected by self-report. Cardiovascular autonomic function indicators included postural hypotension, resting heart rate (HR), as well as HR response to and recovery from submaximal exercise testing (400m walk). Multivariable modeling adjusted for demographic/lifestyle factors, medication use and comorbid conditions. RESULTS In fully adjusted models, poor motor nerve conduction velocity (<40m/s) was associated with greater odds of postural hypotension, (OR=1.6, 95% CI: 1.0-2.5), while poor motor amplitude (<1mV) was associated with 2.3beats/min (p=0.003) higher resting HR. No associations were observed between sensory nerve function or symptoms of peripheral neuropathy and indicators of cardiovascular autonomic function. CONCLUSIONS Motor nerve function and indicators of cardiovascular autonomic function remained significantly related even after considering many potentially shared risk factors. Future studies should investigate common underlying processes for developing multiple PNS impairments in older adults.
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Affiliation(s)
- Brittney S Lange-Maia
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N. Bellefield Ave., 5th Floor, Pittsburgh, PA 15213, United States
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N. Desoto Street., A528 Crabtree Hall, Pittsburgh, PA 15261, United States
| | - John M Jakicic
- Department of Health and Physical Activity, School of Education, University of Pittsburgh, Oak Hill Commons, 32 Oak Hill Court, Pittsburgh, PA 15261, United States
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N. Desoto Street, A510 Crabtree Hall, Pittsburgh, PA 15261, United States
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N. Bellefield Ave., 5th Floor, Pittsburgh, PA 15213, United States
| | - Ann V Schwartz
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA 94158, United States
| | - Eleanor M Simonsick
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, 251 Bayview Boulevard, Suite 100, Baltimore, MD 21224, United States
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, 649 Doctor's Office Building, 66 N. Pauline St., Memphis, TN 38163, United States
| | - Aaron I Vinik
- Department of Neurobiology, Eastern Virginia Medical School, 855 W. Brambleton Avenue, Norfolk, VA 23510, United States
| | - Sasa Zivkovic
- Department of Neurology, University of Pittsburgh, 3471 Fifth Ave. Suite 810, Pittsburgh, PA 15213, United States
| | - Tamara B Harris
- Intramural Research Program, Laboratory of Epidemiology, and Population Sciences, National Institute on Aging, National Institutes of Health, Laboratory of Epidemiology, Demography, and Biometry, Gateway Building, 3C309, 7201 Wisconsin Avenue, Bethesda, MD 20892, United States
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N. Bellefield Ave., 5th Floor, Pittsburgh, PA 15213, United States.
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16
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Doulgerakis D, Moyssakis I, Kapelios CJ, Eleftheriadou I, Chorepsima S, Michail S, Tentolouris N. Cardiac Autonomic Neuropathy Predicts All-Cause and Cardiovascular Mortality in Patients With End-Stage Renal Failure: A 5-Year Prospective Study. Kidney Int Rep 2017; 2:686-694. [PMID: 29142986 PMCID: PMC5678628 DOI: 10.1016/j.ekir.2017.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/13/2017] [Accepted: 03/08/2017] [Indexed: 01/20/2023] Open
Abstract
Introduction Chronic renal disease is associated with increased cardiovascular (CV) mortality. Cardiac autonomic neuropathy (CAN) is predictive of mortality for diseases that affect the autonomic nervous system. We prospectively evaluated the prognostic value of indexes of left ventricular (LV) function and CAN in all-cause and CV mortality of patients with end-stage renal failure (ESRF). Methods A total of 133 patients with ESRF were recruited. LV function was evaluated by echocardiography, whereas cardiac autonomic function was assessed using the battery of the 4 standardized tests proposed by Ewing. Results A total of 123 of 133 (92.5%) patients completed the study and were followed for a mean of 4.9 ± 2.6 years. Mean LV ejection fraction (LVEF) was 50.9 ± 6.9%, whereas 70 (57.9%) patients had CAN. Sixty-nine all-cause and 36 CV deaths were recorded. The survival rates at 3, 5, and 7 years were 77.2%, 57.4%, and 33.7%, respectively. Multivariate analysis after adjustment for waist circumference, current smoking, history of diabetes, and coronary artery disease demonstrated that the only independent predictors of all-cause mortality during follow-up were age, serum triglycerides, LVEF, and presence of CAN. Competing risk regression analysis, after adjusting for waist circumference, coronary heart disease, serum glucose, and triglycerides, indicated that age and presence of CAN were independent risk factors for CV mortality. Discussion Age and presence of CAN are independent predictors of all-cause and CV mortality in patients with ESRF. The functionality of the cardiac autonomic nervous system activity can be used for the risk stratification in patients with ESRF.
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Affiliation(s)
- Dimitrios Doulgerakis
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Chris J Kapelios
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Eleftheriadou
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatia Chorepsima
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Michail
- Department of Nephrology, Laiko General Hospital, Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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17
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Fisher VL, Tahrani AA. Cardiac autonomic neuropathy in patients with diabetes mellitus: current perspectives. Diabetes Metab Syndr Obes 2017; 10:419-434. [PMID: 29062239 PMCID: PMC5638575 DOI: 10.2147/dmso.s129797] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cardiac autonomic neuropathy (CAN) is a common and often-underdiagnosed complication of diabetes mellitus (DM). CAN is associated with increased mortality, cardiovascular disease, chronic kidney disease, and morbidity in patients with DM, but despite these significant consequences CAN often remains undiagnosed for a prolonged period. This is commonly due to the disease being asymptomatic until the later stages, as well as a lack of easily available screening strategies. In this article, we review the latest developments in the epidemiology, pathogenesis, diagnosis, consequences, and treatments of CAN in patients with DM.
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Affiliation(s)
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham
- Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Correspondence: Abd A Tahrani, Institute of Metabolism and Systems Research, Medical School, University of Birmingham, Birmingham B15 2TT, UK, Email
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18
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Fang P, Dong J, Zeng F, Tang Z. Analysis of the association between glucose profiles and β-cell function for diabetic cardiovascular autonomic neuropathy in China. J Diabetes Investig 2016; 8:354-362. [PMID: 27736036 PMCID: PMC5415463 DOI: 10.1111/jdi.12584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/07/2016] [Accepted: 09/25/2016] [Indexed: 12/18/2022] Open
Abstract
AIMS/INTRODUCTION The purpose of the present study was to investigate the severity of glucose profiles and β-cell function associated with diabetic cardiovascular autonomic neuropathy (DCAN) in a Chinese sample. MATERIALS AND METHODS A community-based, cross-sectional study to analyze the risk factors of DCAN was carried out with 455 individuals recruited from a Chinese population. The glucose profile risk score was calculated to identify the association between the severity of the glucose profiles and DCAN. The associations of the severity of the glucose profiles and β-cell function with DCAN were analyzed using multivariable logistic regression. RESULTS Univariate analysis showed that the glucose profiles and homeostatic model assessment of insulin resistance were significantly associated with the DCAN outcome, respectively. Multivariable logistic regression showed that significant associations exist between glucose profile indices and DCAN, after controlling for potential confounding factors (P < 0.01 for all) in both models. Multivariable logistic regression also showed that parameters of β-cell function were associated with the DCAN outcome in the category model (P < 0.1 for all). The glucose profile risk score was independently and significantly associated with the DCAN outcome after controlling for confounding factors (P < 0.001 and P for a trend <0.001). CONCLUSIONS Our observations suggest that parameters of glucose profile indices and β-cell function are significantly and independently associated with DCAN, respectively. There was a tendency toward increased glucose profile risk score with increasing prevalence of DCAN.
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Affiliation(s)
- Ping Fang
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Department of Endocrinology, Shanghai Tongji Hospital, Tongji University, Shanghai, China
| | - Jingcheng Dong
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Institutes of Integrative Medicine, Fudan University, Shanghai, China
| | - Fangfang Zeng
- Department of Endocrinology and Metabolism, Fudan University Huashan Hospital, Shanghai, China
| | - Zihui Tang
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai, China.,Institutes of Integrative Medicine, Fudan University, Shanghai, China
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Gominak SC. Vitamin D deficiency changes the intestinal microbiome reducing B vitamin production in the gut. The resulting lack of pantothenic acid adversely affects the immune system, producing a "pro-inflammatory" state associated with atherosclerosis and autoimmunity. Med Hypotheses 2016; 94:103-7. [PMID: 27515213 DOI: 10.1016/j.mehy.2016.07.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 07/02/2016] [Accepted: 07/12/2016] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVES Vitamin D blood levels of 60-80ng/ml promote normal sleep. The present study was undertaken to explore why this beneficial effect waned after 2years as arthritic pain increased. Pantothenic acid becomes coenzyme A, a cofactor necessary for cortisol and acetylcholine production. 1950s experiments suggested a connection between pantothenic acid deficiency, autoimmune arthritis and insomnia. The B vitamins have been shown to have an intestinal bacterial source and a food source, suggesting that the normal intestinal microbiome may have always been the primary source of B vitamins. Review of the scientific literature shows that pantothenic acid does not have a natural food source, it is supplied by the normal intestinal bacteria. In order to test the hypothesis that vitamin D replacement slowly induced a secondary pantothenic acid deficiency, B100 (100mg of all B vitamins except 100mcg of B12 and biotin and 400mcg of folate) was added to vitamin D supplementation. METHODS Vitamin D and B100 were recommended to over 1000 neurology patients. Sleep characteristics, pain levels, neurologic symptoms, and bowel complaints were recorded by the author at routine appointments. RESULTS Three months of vitamin D plus B100 resulted in improved sleep, reduced pain and unexpected resolution of bowel symptoms. These results suggest that the combination of vitamin D plus B100 creates an intestinal environment that favors the return of the four specific species, Actinobacteria, Bacteroidetes, Firmicutes and Proteobacteria that make up the normal human microbiome. HYPOTHESES 1) Seasonal fluctuations in vitamin D levels have normally produced changes in the intestinal microbiome that promoted weight gain in winter. Years of vitamin D deficiency, however, results in a permanently altered intestinal environment that no longer favors the "healthy foursome". 2) Humans have always had a commensal relationship with their intestinal microbiome. We supplied them vitamin D, they supplied us B vitamins. 3) The four species that make up the normal microbiome are also commensal, each excretes at least one B vitamin that the other three need but cannot make. 4) Improved sleep and more cellular repairs eventually depletes body stores of pantothenic acid, causing reduced cortisol production, increased arthritic pain and widespread "pro-inflammatory" effects on the immune system. 5) Pantothenic acid deficiency also decreases available acetylcholine, the neurotransmitter used by the parasympathetic nervous system. Unopposed, increased sympathetic tone then produces hypertension, tachycardia, atrial arrhythmias and a "hyper-adrenergic" state known to predispose to heart disease and stroke.
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Affiliation(s)
- S C Gominak
- 1635 NE Fremont St., Portland, OR 97212, United States.
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