Vascular calcification in diabetic foot and its association with calcium homeostasis

Swain, Jayshree; Tiwari, Shalbha; Pratyush, DD; Dwivedi, Arun Kumar; Gupta, B. B. P.; Shukla, Ratnakar; Singh, SK

doi:10.4103/2230-8210.104128

Cited by 3 publications

(5 citation statements)

References 7 publications

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“…In this study, 88.2% of the patients had generalized arterial wall calcifications on sonography. This is in agreement with that of Bourron et al [ 26 ] In contrast, the arterial wall calcification seen in this study is much higher than the Indian series reported by Swain et al ,[ 27 ] showing the prevalence of 42%; as well as 43.8% from Ivory Coast as reported by Kodjo et al [ 25 ] In general, calcification of the arterial wall in the intima (a feature of atheroma) and in the media (mediacalcosis) contributes to an arterial occlusive process below the knee and is associated with amputation risks. [ 26 28 ] The prevalence of athermanous plaques in this study (74.5%) was much higher than what was reported by other studies (ranging 38%–45%).…”

Section: Discussionsupporting

confidence: 94%

Doppler sonographic characteristics and clinical outcomes of diabetic foot syndrome: A 5-year audit from a tertiary hospital in northern Nigeria

Ismail,

Lawal,

Gezawa

et al. 2024

J West Afr Coll Surg

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Background: Diabetes foot syndrome is one of the common complications of diabetes. Detailed information on the clinical and vascular characteristics of patients with diabetic foot disease in relation to the outcome of the care provided to these patients will be useful to policymakers and clinicians in early detection and timely interventions for the prevention of disabling complications. Materials and Methods: This is a review of patients with diabetic foot managed in Aminu Kano Teaching Hospital over 5 years (January 2017–May 2022). The sociodemographic characteristics, Wagner classification of the foot, Doppler sonographic characteristics and clinical outcomes, etc., were reviewed. Results: A total of 51 patients were reviewed. Males and females accounted for 56.8% and 43.1%, respectively. Twenty-five patients had Wagner grade 4 ulcers, and fewer patients had Wagner grade 1 and 5-foot ulcers. The mean ± standard deviation Doppler arterial intimal media thickness was 1.53 ± 0.33 (range 0.90–2.40 mm). The majority of DFS patients had Doppler sonographic lesions on the right lower limb 28 (54.9%) only, and 11 (21.6%) of the lesions were bilateral. The posterior tibial artery 11 (21.6%) was the most involved arterial segment with plaques, followed by a combination of popliteal and tibial arterial 10 (19.6%) segments. At 6 months, 45.2% had limb amputation, 17.6% healed ulcers, 17.6% delayed wound healing, and 9.8% died. Conclusion: There is an unacceptably high prevalence of poor treatment outcomes, thus, contributing to a huge burden of care to patients living with diabetes. There is a strong association between severe arterial stenosis detected by Doppler ultrasound and higher rates of amputations.

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Section: Discussionsupporting

confidence: 94%

Doppler sonographic characteristics and clinical outcomes of diabetic foot syndrome: A 5-year audit from a tertiary hospital in northern Nigeria

Ismail,

Lawal,

Gezawa

et al. 2024

J West Afr Coll Surg

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“…and Yarahmadi et al.) ( 30 , 34 ) with the lowest risk assessment scores, does not alter the original results (mean = 20.53, 95% CI: 18.90, 22.15). The result of the sensitivity analysis is depicted in Figure 5 .…”

Section: Resultsmentioning

confidence: 61%

“…Nine (24.32%) each were reported from India ( 18 , 25 , 26 , 30 , 40 , 47 – 50 ), and Iran ( 13 , 16 , 20 – 22 , 24 , 34 , 39 , 45 ), three (8.10%) from Turkey ( 27 , 36 , 43 ), two (5.40%) each from China ( 33 , 37 ) and Nigeria ( 41 , 42 ), and one (2.70%) each from Italy ( 19 ), Bulgaria ( 31 ), Greece ( 32 ), Pakistan ( 28 ), Bahrain ( 29 ), USA ( 15 ), Germany ( 38 ), Australia ( 35 ), Spain ( 44 ), Mexico ( 46 ), Denmark ( 17 ), and Slovakia ( 23 ). Number of DFU patients (men and women) ranged from 19 to 387.…”

Section: Resultsmentioning

confidence: 99%

“…The combined results showed similar calcium levels in both groups (MD: -0.17 mg/dL, 95% CI: -0.60, 0.26; P =0.43; I 2 = 92%). A total of four studies measured calcium in DFU (n=567) ( 28 , 30 – 32 ), with mean levels of 9.10 mg/dL, 95% CI: 8.71, 9.49; P <00001; I 2 = 95%.…”

Section: Resultsmentioning

confidence: 99%

“…Swain et al. reported that nearly 52% of DFU patients with vascular calcification (VC) had severe VDD ( 30 ). Their subgroup analyses showed that the risk for VC was 2.4 times higher in patients with vitamin D levels < 10 ng/ml.…”

Section: Discussionmentioning

confidence: 99%

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The association between micronutrient levels and diabetic foot ulcer: A systematic review with meta-analysis

et al. 2023

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BackgroundDiabetic foot ulcers (DFU) are a major complication of diabetes mellitus (DM). Nutrient deficiencies are among the major risk factors in DFU development and healing. In this context, we aimed to investigate the possible association between micronutrient status and risk of DFU.MethodsA systematic review (Prospero registration: CRD42021259817) of articles, published in PubMed, Web of Science, Scopus, CINAHL Complete, and Embase, that measured the status of micronutrients in DFU patients was performed.ResultsThirty-seven studies were considered, of which thirty were included for meta-analysis. These studies reported levels of 11 micronutrients: vitamins B9, B12, C, D, E, calcium, magnesium, iron, selenium, copper, and zinc. DFU, compared to healthy controls (HC) had significantly lower vitamin D (MD: -10.82 14 ng/ml, 95% CI: -20.47, -1.16), magnesium (MD: -0.45 mg/dL, 95% CI: -0.78, -0.12) and selenium (MD: -0.33 µmol/L, 95% CI: -0.34, -0.32) levels. DFU, compared to DM patients without DFU, had significantly lower vitamin D (MD: -5.41 ng/ml, 95% CI: -8.06, -2.76), and magnesium (MD: -0.20 mg/dL, 95% CI: -0.25, -0.15) levels. The overall analysis showed lower levels of vitamin D [15.55ng/ml (95% CI:13.44, 17.65)], vitamin C [4.99µmol/L (95% CI:3.16, 6.83)], magnesium [1.53mg/dL (95% CI:1.28, 1.78)] and selenium [0.54µmol/L (95% CI:0.45, 0.64)].ConclusionThis review provides evidence that micronutrient levels significantly differ in DFU patients, suggesting an association between micronutrient status and risk of DFU. Therefore, routine monitoring and supplementations are warranted in DFU patients. We suggest that personalized nutrition therapy may be considered in the DFU management guidelines.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=259817, identifier CRD42021259817.

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Raised serum 25-hydroxyvitamin D levels in patients with active diabetic foot ulcers

et al. 2016

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Studies have emerged to demonstrate bidirectional changes in circulating cytokines of inflammation in active diabetic foot ulcers (DFU). To further expand the understanding of inflammatory status present in chronic active DFU, we comparatively assessed the associations of selected pro-inflammatory cytokines and 25-hydroxyvitamin D (25(OH)D) with the presence of DFU. In a cross-sectional setting, thirty patients with type 2 diabetes and active DFU matched with thirty control non-ulcerative patients with type 2 diabetes and twenty-eight healthy subjects underwent anthropometric and biochemical assessment of study parameters. Recruited patients with DFU were selected from the grade II active chronic DFU at the time of hospitalisation according to the University of Texas wound classification system. Patients with DFU and controls had comparable age, sexual distribution, diastolic blood pressure and TAG, LDL-cholesterol and glycated Hb. The trend changes from healthy controls towards DFU showed a significant increase for serum monocyte chemoattractant protein-1, IL-6, 25(OH)D and highly sensitive C-reactive protein and a decrease for IL-8. In the multivariate adjusted logistic regression model, 25(OH)D emerged as the only independent correlate of DFU (OR 2·194; 95 % CI 1·003, 4·415). Unprecedented increase of serum 25(OH)D in chronic active DFU is possibly related to a selective alteration in the inflammatory status. In particular, 25(OH)D and IL-8 seem to share a common pathway in the pathogenesis of diabetic foot.

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Vascular calcification in diabetic foot and its association with calcium homeostasis

Cited by 3 publications

References 7 publications

Doppler sonographic characteristics and clinical outcomes of diabetic foot syndrome: A 5-year audit from a tertiary hospital in northern Nigeria

Doppler sonographic characteristics and clinical outcomes of diabetic foot syndrome: A 5-year audit from a tertiary hospital in northern Nigeria

The association between micronutrient levels and diabetic foot ulcer: A systematic review with meta-analysis

Raised serum 25-hydroxyvitamin D levels in patients with active diabetic foot ulcers

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