A study on diabetic foot and its association with peripheral artery disease

Abstract

Background: Diabetes mellitus is characterized by high blood sugar levels over a prolonged period due to alteration in either the insulin secretion, insulin action, or both. Worldwide, as of the recent 2016 data collected from the World Health Organization (WHO) around 422 million adults have diabetes mellitus which is estimated to almost double by 2030 which is composed of mainly type 2 diabetes (85-90% of all cases). The early detection of peripheral artery disease in asymptomatic patients goes a long way in reduction of major lower limb amputations and mortality. Hence, there is a need for evaluation of peripheral vascular disease in all diabetics, especially those with diabetic foot by formulating effective management protocols, thereby limiting the morbidity, mortality and social costs associated with the disease.Methods: Patients admitted and seen in out-patient department for diabetic foot ulcers between January 2013 and October 2013 in Department of general surgery, vascular surgery and diabetology, Kilpauk Medical College Hospital, Chennai, India were taken for study.Results: 150 cases satisfying the inclusion criteria were taken up for the study from January 2013 to October 2013. Out of 150 patients, 76 patients presented with ulcer in foot, 34 presented with gangrene of toe or foot. After clinical examination it was found that 52 patients had associated neuropathy, 17 patients had ABI less than 0.3 and 39 patients had ABI in between 0.4 and 0.9. Patients with ulcer and gangrene in foot and with ABI less than 0.9 were admitted and evaluated with doppler study of lower limbs. After getting consent, appropriate procedure was done for each patient. Wound debridement was done in 21 cases, toe disarticulation in 12, fore foot amputations in 4, Below knee amputation in 9, above knee amputation in 3. 11 patients were referred to vascular surgery and underwent revascularization procedures (BYPASS).Conclusions: The prevalence of peripheral artery disease in patients with diabetic foot is significantly high i.e. 38 % as per this study. Males have a higher predilection for developing peripheral vascular disease than females. The average age of presentation of PAD in diabetics is 40 -60 years. The most common level of arterial occlusion in PAD associated diabetic foot is femoro-popliteal segment followed by tibial segment.

Building Blood Vessels with Vascular Progenitor Cells

“…Diabetes also increases the risk of amputation for patients dealing with high blood pressure-induced peripheral artery disease, which is caused by a narrowing of the artery and reduction of blood flow [1]. Other conditions such as stroke or coronary, renal, and pulmonary disease can result from blood pressure dysregulation, reduction of blood flow, and vascular occlusion [2–5]. Over 370 million people worldwide suffer from diabetes and costs related to cardiovascular disease and stroke is currently >$300 billion annually and will exceed $1 trillion by 2035 [6, 7].…”

Prevalence of Peripheral Arterial Disease in Diabetic Foot Ulcer Patients and its Impact in Limb Salvage

“…11 Another study reported that the prevalence of PAD in cases with diabetic foot syndrome was 38%, as PAD was diagnosed in 57 out of 150 included cases. 12 Aljarid et al 6 also reported that PAD had a prevalence of 32.2% in the included diabetic population. 6…”

“…Another study reported that amputation was required in 49.12% of diabetic foot with PAD. 4,12 The presence of PAD has been confirmed as a significant risk factor for amputations in the diabetic population. 29,30 PAD will eventually lead to poor perfusion, delayed wound healing, and increased susceptibility to infections.…”

An Overview of Diabetic Foot Ulcers and Associated Problems with Special Emphasis on Treatments with Antimicrobials

“…It is possible that the endothelium will show signs of reduced local angiogenesis, endocrine cell proliferation, basement membrane thickness, blood viscosity, changes in microvascular sound, and antioxidant potential. It might also show signs of reduced smooth muscle cell proliferation [ 31 ].…”