A fact-finding survey on pre-ulcerative lesions of foot in patients with diabetes: analysis using the Diabetes Study from the Center of Tokyo Women's Medical University 2018 (DIACET 2018)

Aims/introduction

We aimed to identify the frequency and risk factors of pre-ulcerative lesions of foot in Japanese individuals with diabetes.

Materials and methods

This was a single-center cross-sectional observational study. We conducted a questionnaire survey of 5029 individuals with diabetes (mean age 63 years; 2185 women; 1015 individuals with type 1 diabetes and 4014 individuals with type 2 diabetes) who (a) participated in the Diabetes Study from the Center of Tokyo Women's Medical University: DIACET 2018, and (b) responded to the presence of pre-ulcerative lesions of foot. A pre-ulcerative lesions of foot was defined as a calluses, ingrown nails, or symptoms of fungal infection. The associations between pre-ulcerative lesions of foot and commonly available clinical information were examined using the logistic regression analysis.

Results

412 of 1015 (40.6%) individuals with type 1 diabetes and 1585 of 4014 (39.5%) individuals with type 2 diabetes reported having any type of pre-ulcerative lesions of foot. The frequency of calluses, ingrown nails, and symptoms of fungal infection, respectively, were 16.8%, 15.8%, and 21.9% in type 1 diabetes and 10.5%, 18.5%, and 24.7% in type 2 diabetes. In the separate analysis by type of diabetes, common risk factors found to be significantly correlated with pre-ulcerative lesions of foot were female gender, numbness in the feet and foot deformation.

Conclusion

Proactive foot screening by health care professionals was considered important, especially in individuals with type 1 and type 2 diabetes with advanced complications and foot deformation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13340-023-00649-7.

Optimising both disease control and glucocorticoid dosing is essential for bone protection in patients with rheumatic disease

OBJECTIVES

Inflammatory rheumatic and musculoskeletal diseases (iRMDs) are associated with increased systemic bone loss that is mediated by chronic inflammation, treatment with glucocorticoids (GCs) and other factors. Our objective was to analyse the impact of variables that influence osteoporosis (OP) in patients with iRMD treated with GC.

METHODS

Rh-GIOP (acronyme) is a prospective observational cohort study investigating bone health in consecutive patients with iRMD and current or prior GC treatment. We present an analysis of the patients' baseline data here. Bone mineral density (BMD) measured by dual X-ray absorptiometry was the primary outcome. Multivariable linear regression models were performed to identify variables associated with BMD.

RESULTS

Data from 1066 patients with iRMD were analysed. GC doses of <5 mg prednisone equivalent per day, cumulative dose and duration of GC therapy were not associated with negative effects on BMD. Dosages of ≥5 mg/day lost their negative association with BMD after adjustment for confounders. When subanalysing patients with exactly 5 mg/day, no negative effect was seen. For patients with rheumatoid arthritis (RA), GC doses of >7.5 mg/day showed a negative association with BMD overall, but this effect seemed to be specific only to patients with moderate or high disease activity (Disease Activity Score 28-C reactive protein >3.2).

CONCLUSIONS

GCs of ≤5 mg/day did not seem to be associated with a reduction of BMD in patients with iRMD and current or prior exposure to GC. This is most likely due to the dampening of inflammation by GC, which exerts a mitigating effect on the risk of OP. In RA, current GC doses of >7.5 mg/day were negatively associated with BMD, but only in patients with moderate to high disease activity.

TRIAL REGISTRATION NUMBER

NCT02719314.

Randomized trial of an intensified, multifactorial intervention in patients with advanced-stage diabetic kidney disease: Diabetic Nephropathy Remission and Regression Team Trial in Japan (DNETT-Japan)

AIMS/INTRODUCTION

We evaluated the efficacy of multifactorial intensive treatment (IT) on renal outcomes in patients with type 2 diabetes and advanced-stage diabetic kidney disease (DKD).

MATERIALS AND METHODS

The Diabetic Nephropathy Remission and Regression Team Trial in Japan (DNETT-Japan) is a multicenter, open-label, randomized controlled trial with a 5-year follow-up period. We randomly assigned 164 patients with advanced-stage diabetic kidney disease (urinary albumin-to-creatinine ratio ≥300 mg/g creatinine, serum creatinine level 1.2-2.5 mg/dL in men and 1.0-2.5 mg/dL in women) to receive either IT or conventional treatment. The primary composite outcome was end-stage kidney failure, doubling of serum creatinine or death from any cause, which was assessed in the intention-to-treat population.

RESULTS

The IT tended to reduce the risk of primary end-points as compared with conventional treatment, but the difference between treatment groups did not reach the statistically significant level (hazard ratio 0.69, 95% confidence interval 0.43-1.11; P = 0.13). Meanwhile, the decrease in serum low-density lipoprotein cholesterol level and the use of statin were significantly associated with the decrease in primary outcome (hazard ratio 1.14; 95% confidence interval 1.05-1.23, P < 0.001 and hazard ratio 0.53, 95% confidence interval 0.28-0.998, P < 0.05, respectively). The incidence of adverse events was not different between treatment groups.

CONCLUSIONS

The risk of kidney events tended to decrease by IT, although it was not statistically significant. Lipid control using statin was associated with a lower risk of adverse kidney events. Further follow-up study might show the effect of IT in patients with advanced diabetic kidney disease.