The importance of HbA1C and erythrocyte sedimentation rate as prognostic factors in predicting the outcome of diabetic foot ulcer disease

Abstract

Background:The study is to determine the relation between the high HbA1c and ESR as prognostic factors with the severity of the diabetic foot ulcer disease, particularly, in predicting the final outcome in the form of higher incidence of lower extremity amputation (LEA) and/or prolonged hospital stay. The study explored the importance of increased level of serum HbA1c and erythrocyte sedimentation rate (ESR) in determining the final outcome of the disease. It revealed that the severity of diabetic foot ulcer disease is more in patients who had concomitant high levels of baseline HbA1c and ESR on admission. Methods: This observational study was done in 89 patients who were admitted in the surgical wards of the two teaching hospitals in India. The cohort consisted of patients from the age of 26 to 83 years of age who presented with clinically infected foot ulcers. Routine blood tests were done which include HbA1C on the day of admission and fasting ESR (1st hour) on the next day morning. The standard X-ray plates were routinely taken on the first day for determination of the involvement of underlying bones and soft tissues. The outcome of the diabetic foot ulcer was assessed from the severity of the disease according to Meggit-Wagner classification, the incidence of lower extremity amputation and the duration of hospital stay. Results: The high levels of baseline HbA1C (more than 7.0%) in blood on the first day of admission was found in all of the 89 patients who were included in this study but the criteria for consideration of high risk was more than 9% which was found in 41 patients. The criteria for consideration of high ESR in this study was set to be 50 mm/h. High ESR of more than 50 mm was found in 63 patients. We had subdivided 31 patients into a High Risk Group whose baseline levels of HbA1C > 9% and ESR > 50 mm/h. The incidence of amputation was 79.31% and 44.44% with HbA1c of more than 9.0% and ESR of more than 50 mm respectively and was considerably increased (83.87%) when both HbA1c and ESR were more than the critical value as set in the study. Similarly, the incidence of prolonged hospital stay of more than 14 days was 58.54% in patients with HbA1C level of greater than 9 %, 51.85% in patients with baseline ESR > 50 mm/h and 93.55% in presence of high levels of both HbA1C (>9%) and ESR (>50 mm/h).. Conclusions: The study observed that the patients who presented with baseline high levels of HbA1C, ESR or both on admission had unfavourable prognosis with increased incidence of lower extremity amputation and prolonged hospital stay than the other patients in the cohort. .

Association of Erythrocytes Sedimentation Rate and Platelets Indices in Diabetes in the Elderly

“…Revelations made from the study show that ESR levels were greater in the diabetes group than in the non-diabetic group, measuring 37.42±20.20 and 29.78±13.26 at (p<0.029) respectively. The higher ESR levels seen in diabetes patients in this study are consistent with findings of Pal et al (2017), who found comparable results in their studies. The ESR outcome of this study, however, differs from that of others, such as Heo et al (2012), who found that diabetic individuals with myocardial infarction did not have an elevated ESR, with a p-value of (p<0.20).…”

The relationship between hepcidin and anemia in controlled and uncontrolled Type-2 Diabetes Mellitus (T2DM) patients at Sanglah Hospital, Bali, Indonesia

“…According to a study conducted by Bikramjit P et al, there was an increase in the ESR more than 50 mm/hour in patients with T2DM who had an HbA1c value of 7% and an increase in the ESR more than 90 mm/hour in DM patients who had an HbA1c value of more than 9%. 29 Hepcidin is a 25 amino acid peptidase hormone that inhibits iron entry into the plasma compartment through 3 sources of iron supply, namely absorption of food in the duodenum, the release of iron from macrophages and release of stored iron from hepatocytes. 30 Hepcidin is mainly produced in the liver, but hepcidin is also produced in small amounts in other tissues such as the heart, kidney, pancreas and hematopoietic cells.…”

Telemedicine for the Self-Management of Type 2 Diabetes: A Literature Review

“…Almost all journals showed a significant decrease in HbA1c on the group intervention compared to the control group. HbA1c is an established marker to monitor diabetic status (Bikramjit, Raveender, and Sudipta, 2017). Glucose control is important for diabetics but HbA1c is the benchmark for diabetes management.…”