An evaluation of ischaemia-modified albumin levels in the development of diabetic foot ulcer

A systematic review and meta-analysis of ischemia-modified albumin in diabetes mellitus

Aim

There is an ongoing search for novel biomarkers of diabetes. We conducted a systematic review and meta-analysis of the serum concentrations of ischemia-modified albumin (IMA), a candidate biomarker of oxidative stress, acidosis, and ischemia, in patients with pre-diabetes, different types of diabetes mellitus (type 1, T1DM, type 2, T2DM, and gestational, GDM), and healthy controls.

Methods

We searched for case-control studies published in PubMed, Web of Science, and Scopus from inception to December 31, 2023. The risk of bias and the certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively.

Results

In 29 studies, T2DM patients had significantly higher IMA concentrations when compared to controls (standard mean difference, SMD = 1.83, 95 % CI 1.46 to 2.21, p˂0.001; I2 = 95.7 %, p < 0.001; low certainty of evidence). Significant associations were observed between the SMD and glycated hemoglobin (p = 0.007), creatinine (p = 0.003), triglycerides (p = 0.029), and the presence of diabetes complications (p = 0.003). Similar trends, albeit in a smaller number of studies, were observed in T1DM (two studies; SMD = 1.59, 95 % CI -0.09 to 3.26, p˂0.063; I2 = 95.8 %, p < 0.001), GDM (three studies; SMD = 3.41, 95 % CI 1.14 to 5.67, p = 0.003; I2 = 97.0 %, p < 0.001) and pre-diabetes (three studies; SMD = 15.25, 95 % CI 9.86 to 20.65, p˂0.001; I2 = 99.3 %, p < 0.001).

Conclusion

Our study suggests that IMA is a promising biomarker for determining the presence of oxidative stress, acidosis, and ischemia in pre-diabetes and T1DM, T2DM, and GDM. However, the utility of measuring circulating IMA warrants confirmation in prospective studies investigating clinical endpoints in pre-diabetes and in different types of diabetes (PROSPERO registration number: CRD42024504690).

Comparison of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and C-reactive protein in predicting osteomyelitis in patients with diabetic foot ulcer

Introduction

Neutrophil/lymphocyte ratio (NLR) and platelet/ lymphocyte ratio (PLR) are readily available and inexpensive biomarkers that have received great attention for diagnosing type 2 diabetes(T2DM) complications. The objective of the present cross-sectional study was to compare diagnostic values of these biomarkers with C-reactive protein(CRP) in detecting diabetic foot ulcer (DFU) and osteomyelitis (OS) and discriminating between the degree of DFU according to Wagner's classification.

Methods

A total of 217 individuals (42 healthy controls, 40 T2DM patients without DFU, and 135 patients with DFU) were enrolled. The DFU patients were classified according to Wagner's classification into grade 1, grade 2, and grade 3. Blood samples were obtained and various biochemical and hematological parameters including creatine, CRP, HbA1c, NLR, and PLR were measured.

Results

The levels of CRP, PLR, and NLR were significantly higher in the patients with DFU and OS compared to healthy controls and T2DM patients without DFU. The median values of CRP were correlated with the severity of DFU and increased with DFU grades. The highest values of CRP, NLR, and PLR were observed in the DFU patients with OS which were significantly higher than those of DFU patients with grades 1 and 2 as well as T2DM patients without DFU. The PLR and NLR had no significant performance in diagnosing DFU patients with grades 1 and 2 from the patients without DFU.

Conclusion

NLR and PLR could be useful for diagnosing OS but cannot be used for detecting lower grades of DFU. CRP showed higher performance in detecting OS compared to PLR and NLR.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01327-w.

Factors Influencing Wound Healing in Diabetic Foot Patients

Background and objectives: Diabetic foot stands out as one of the most consequential and devastating complications of diabetes. Many factors, including VIPS (Vascular management, Infection management, Pressure relief, and Source of healing), influence the prognosis and treatment of diabetic foot patients. There are many studies on VIPS, but relatively few studies on "sources of healing". Nutrients that affect wound healing are known, but objective data in diabetic foot patients are insufficient. We hypothesized that "sources of healing" would have many effects on wound healing. The purpose of this study is to know the affecting factors related to the source of healing for diabetic foot patients. Materials and Methods: A retrospective review identified 46 consecutive patients who were admitted for diabetic foot management from July 2019 to April 2021 at our department. Several laboratory tests were performed for influencing factor evaluation. We checked serum levels of total protein, albumin, vitamin B, iron, zinc, magnesium, copper, Hb, HbA1c, HDL cholesterol, and LDL cholesterol. These values of diabetic foot patients were compared with normal values. Patients were divided into two groups based on wound healing rate, age, length of hospital stay, and sex, and the test values between the groups were compared. Results: Levels of albumin (37%) and Hb (89%) were low in the diabetic foot patients. As for trace elements, levels of iron (97%) and zinc (95%) were low in the patients, but levels of magnesium and copper were usually normal or high. There were no differences in demographic characteristics based on wound healing rate. However, when compared to normal adult values, diabetic foot patients in our data exhibited significantly lower levels of hemoglobin, total protein, albumin, iron, zinc, copper, and HDL cholesterol. When compared based on age and length of hospital stay, hemoglobin levels were significantly lower in both the older age group and the group with longer hospital stays. Conclusions: Serum levels of albumin, Hb, iron, and zinc were very low in most diabetic foot patients. These low values may have a negative relationship with wound healing. Nutrient replacements are necessary for wound healing in diabetic foot patients.

The Preoperative Neutrophil-Lymphocyte Ratio Is an Independent Predictive Factor in Predicting 1-Year Mortality in Amputated Diabetic Foot Patients

In this study, we aimed to evaluate the efficacy of neutrophil/lymphocyte ratio values in preoperative blood tests of patients amputated due to diabetic foot in predicting 1-year mortality. We assumed that the neutrophil/lymphocyte ratio predicted 1-year mortality in these patients. The inclusion criteria were as follows: to be diagnosed with diabetic foot, being >18 years of age, having a confirmed type 1 or type 2 diabetes mellitus diagnosis, stage 3 to 5 Wagner ulcers, and having at least 1 year of follow-up. The patients with acute traumatic injuries observed in less than 1 week, traumatic amputations, and nondiabetic amputations, and those whose data could not be obtained were excluded from the study. After the exclusion, 192 patients were included in the study. Age (p < .001), low preoperative hemoglobin (p = .024), high preoperative neutrophil (p < .001), low preoperative lymphocyte (p = .023), low preoperative albumin (p < .001), high preoperative neutrophil-to-lymphocyte ratio (p < .001), major amputation (p = .002), and were related to 1-year mortality. According to these results: (1) it was observed that a preoperative neutrophil/lymphocyte ratio value over 5.75 increases the risk of death 1.1 times and (2) it was observed that a preoperative albumin value under 2.67 increases the risk of death 5.74 times. In conclusion, the age, preoperative neutrophil/lymphocyte ratio, and albumin values of patients planning to undergo amputation surgery can be independent predictive factors in predicting 1-year mortality.

Diagnostic values of ischemia modified albumin in diabetes-related complications: a narrative review

Purpose

Oxidative stress (OS) plays a critical role in the onset and progression of macro and microvascular complications of diabetes mellitus (DM). Ischemia-modified albumin (IMA) is a novel and simple test for evaluating OS. In the present study, we reviewed the available information on the alteration of circulating IMA in DM and its possible prognostic and diagnostic value in DM-related complications.

Methods

Relevant studies regarding IMA alteration in DM published until May 30, 2022 were extracted from Google Scholar, PubMed, Scopus, and Science Direct databases. The following key words were used: IMA, DM, diabetes complications, retinopathy, nephropathy, diabetic foot, and vascular complications.

Results

This review revealed increased circulating IMA levels in the patients with type 1, type 2, and gestational DM. Furthermore, IMA showed a close relationship with the severity of DM complications including hyperglycemia, dyslipidemia, diabetic retinopathy, diabetic nephropathy, peripheral arterial disease, and diabetic foot ulcer. However, lack of assay standardization and low specificity are major obstacles to the use of IMA as a promising biomarker.

Conclusion

IMA levels are associated with DM complications and can be applied as a practical test for evaluating the risk and predicting the severity of DM complications.

The Relationship between Ozone and Human Blood in the Course of a Well-Controlled, Mild, and Transitory Oxidative Eustress

In the last twenty years there has been a proliferation of articles on the therapeutic use of ozone. As it is well-known, the term ozone therapy is very broad. It ranges from either systemic or loco-regional administration of unstable gaseous oxygen/ozone mixtures to the topical application of stable ozonated derivatives. Anyway, in relation to the absence of specific receptors and the extreme reactivity with the biological liquids with which it comes into contact, gaseous ozone cannot be classified as either a drug or a pro-drug. When the gaseous ozone impacts a biological matrix, both reactive oxygen species (ROS) and lipid oxidation products (LOPs) are formed. They represent the effector molecules responsible for modulating the therapeutic activity in the body. Apart from the merits of the action mechanisms resulting from the use of ozone, this article seeks to validate the practice of ozone therapy as an adjuvant treatment in full compliance with the physiology of the whole organism.

Is ischaemia-modified albumin a biomarker in wagner classification in diabetic foot ulcers?

BACKGROUND

We aimed to determine the relationship of ischaemia-modified albumin (IMA) with diabetic foot ulcers and its predictive value in the Wagner classification.

METHODS

Our cross-sectional study was conducted in 120 diabetic foot patients and 60 healthy individuals with similar body mass index (BMI) and age. Patients with a diabetic foot were classified according to the Wagner classification. Biochemical parameters, C-reactive protein (CRP) and IMA levels were measured in all patients and healthy volunteers. Screening performance characteristics of CRP and IMA were calculated according to Wagner classes and the presence of osteomyelitis.

RESULTS

The levels of BMI, CRP and IMA in diabetic foot patients were significantly higher than the healthy controls. When we grouped the patients according to the Wagner classification, there were no significant differences between the Wagner groups in terms of BMI. The highest IMA levels were detected in Wagner grade 5. CRP had higher sensitivity and specificity than IMA in the discrimination of other grades, except for grade 4-5 separation. For Wagner grade 4-5 distinction, IMA had 84.6% sensitivity and 94.7% specificity.

CONCLUSION

IMA had a higher predictive value in discrimination of the Wagner grade 4-5. In the management of diabetic foot patients, it may be recommended that IMA is evaluated by clinicians.