Charcot osteoarthropathy in type 2 diabetes persons presenting to specialist diabetes clinic at a tertiary care hospital

Abstract

BackgroundCharcot osteoarthropathy or charcot foot is a rare, chronic, non-communicable condition of bones and joints which may results into severe deformity and more prone to develop ulcers possibly leading to amputation. The purpose of this study was to determine the prevalence of Charcot osteoarthropathy and its association with age, BMI, gender, duration of diabetes, HBA1c and peripheral neuropathy.MethodsA total of 1931 subjects with type 2 diabetes having mean age 50.72 ± 10.66 years presenting in a specialist diabetes clinic at shalamar hospital, Lahore, Pakistan were enrolled. The diagnosis of Charcot osteoarthropathy was made by examination of both dorsal and plantar surfaces of foot for swelling, erythema, increase in temperature and any musculoskeletal deformity which was later confirmed by radiographs. Assessment of neuropathy was carried out by checking the sense of pressure, joint position and vibration. BMI (Body Mass Index), fasting blood glucose (FBG) and HbA1C were determined.ResultsIn all subjects including male 704 (36.45 %) and female 1227 (63.55 %), 0.4 % subjects had charcot deformity, while 0.2 %, 0.15 % and 0.05 % subjects having right, left and bilateral deformity respectively. Bilaterally symmetrical neuropathy was diagnosed in 25.4 % in subjects. There was a significant association (p < 0.05) of deformity with duration of diabetes, HbA1C and neuropathy, however no significant association (p > 0.05) was found with age, BMI, weight, height and gender.ConclusionThere is a need to have a special care of persons with diabetes regarding blood glucose control and development of peripheral neuropathy. Early identification and management of risk factors may prevent the occurrence of charcot deformity. Patients must be educated about the foot care.

The effect of cumulative glycemic burden on the incidence of diabetic foot disease

“…Lastly, increasing age was associated with lower incidence of Charcot arthropathy. Previous studies have found an increased incidence in diabetics over the age of 60 and an association with longer disease duration, while others show no association with age [13, 14]. Our findings with regard to age, while meeting statistical significance, are likely not clinically significant, and thus, heightened surveillance for Charcot arthropathy should be maintained for diabetics in all age groups.…”

“…One of the most important findings of our study was that diabetics with foot ulcer not only had a significantly higher mean HbA1c but also a greater cumulative glycemic burden than those without ulcer. Previous studies have shown that hyperglycemia at one or multiple time points and duration of diabetic disease are positively associated with diabetic foot ulcer, but no study to date has accounted for varying glycemic control during the time of disease [11, 14, 15, 21, 22]. We found a statistically significant step-wise increase in the incidence of foot ulcer with worsening cumulative glycemic burden.…”

Prevalence of Charcot arthropathy in Type 2 diabetes patients aged over 50 years with severe peripheral neuropathy: A retrospective study in a Tertiary Care South Indian Hospital

“…[ 19 ] In another study done by Younis et al ., patients within the age group of 60–79 had higher propensity to develop CA, compared to other age groups. [ 13 ] In the present study, the average age at the time of diagnosis of CA was 63, and this may be due to the fact that our study population itself was above the age of 50 years.…”

“…[ 12 ] In a recent study conducted in a specialty clinic for diabetes in Pakistan, the prevalence of CA was found to be 0.4% in patients with diabetes. [ 13 ]…”

“…on DM population of Pakistan, no gender-related difference in presentation of CA was noted. [ 13 ] Many studies conclude male gender as a risk factor for developing Charcot foot. Even in the present study, an increased prevalence of CA was observed in males compared to females.…”