OBJECTIVESubclinical inflammation is an important risk factor for type 2 diabetes and diabetes complications. However, data on the association between inflammation and acute diabetic foot syndrome are scarce. The aim of this study was to compare systemic immune mediators in diabetic patients with and without an ulcer and to identify modulating factors.RESEARCH DESIGN AND METHODSCirculating levels of acute-phase proteins, cytokines, and chemokines were measured in diabetic patients with an ulcer (n = 170) and without an ulcer (n = 140). Of the patients, 88% had type 2 diabetes.RESULTSPatients with an acute foot ulcer had higher levels of C-reactive protein (CRP), fibrinogen, interleukin (IL)-6, macrophage migration inhibitory factor, macrophage inflammatory protein-1α, and interferon-γ–inducible protein-10 as well as lower levels of RANTES (regulated on activation normal T-cell expressed and secreted) (all P < 0.01). No differences were found for IL-8, IL-18, and monocyte chemoattractant protein-1. Most of these associations persisted after adjustment for demographic and anthropometric data, metabolic confounders, and diabetes complications. In multivariate models, size of ulcer according to the University of Texas classification but not the grade of infection was independently associated with three markers of subclinical inflammation (CRP, IL-6, and fibrinogen).CONCLUSIONSWe demonstrate in our cross-sectional study that acute foot ulcers and their severity are associated with a marked upregulation of acute-phase proteins, cytokines, and chemokines independently of the concomitant infection. Further studies should investigate whether an activation of the immune system precedes the development of foot ulcer and whether anti-inflammatory therapies might be effective.

These results indicate that psychotherapeutic intervention during in-patient treatment can have a positive influence on anxiety, depressive symptoms and diabetes-related problems in patients with diabetic foot syndrome.

At the beginning of the treatment 18% of the inpatients suffered from severe depressive symptoms, and 16.2 % suffered from moderate depressive symptoms. 16.4% of the patients suffered from severe anxiety, and 24.7% suffered from moderate anxiety (HADS). The prevalence rate of the type D pattern was 33.0%. The extent of anxiety and depression was not, as had been anticipated, associated with the severity of the physical symptoms. Although the diabetic foot syndrome improved significantly in most of the patients, the extent of depressive symptoms, anxiety and diabetes-related problems remained almost the same.

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