Endocrine Abstracts

Background and aims: Foot lesions (amputations, ulcerations) are the consequence of neuro-vascular complications. Cardiovascular risk factors are similar for both. Thus, we carried out a prospective 5-year study to examine the effects of established complications and classical risk factors on mortality in diabetic patients.

Materials and methods: During the previous 5 years we analyzed 244 patients attending a diabetes clinic. The International Working Group on Diabetic Foot (IWGDF) risk categorization was used to quantify the severity of foot pathology. Retinopathy was diagnosed by funduscopy. Peripheral neuropathy diagnosed by the Neuropathy Disability Score (NDS) and Neuropad time to color change were studied as well. Coronary artery disease (CAD) and lower extremity arterial disease (LEAD)] were evaluated. Cardiovascular risk factors were: hypertension, triglycerides, HDLc, LDLc, diabetes duration, fibrinogen, proteinuria, smoking. 53 patients (group A) had meanwhile died, and 191 (group B) are still alive.

Results: There were no differences between groups A and B in the following parameters: male gender [31(58.5%) vs. 94(49.2%), P=0.23], diabetic retinopathy [34 (64.15%) vs. 105(54.97%), P=0.29], proteinuria (385.2±609.9 vs. 443.9±1003, P=0.23), CAD [5(9.43%) vs. 16(8.38%), P=0.81], [triglycerides (1.9±1.51 vs. 1.93±1.7 mmol/l, P=0.90), HDLc (1.27±0.51 vs 1.25±0.28 mmol/l, P=0.80), LDLc (3.44±0.81 vs 3.62±0.89 mmol / l, P=0.18)], [type 1 diabetes [6 (11.3%)). 24 (12.6%), P=0.80], HbA1c (8.9%±2.04 vs. 9.2±1.94%, P=0.17)], smoking [7 (13.2%) vs. 36(18.8%), P=0.34]. Patients in group A exhibited significant differences in the following parameters: IWGDF risk category 2/3 (P=0.0002), VPT (3.35±3.2 vs. 4.8±3.00 V, P=0.004), Neuropad response (13.8±8.9 P=0.03), age at developing foot lesions (69.2±8.77 vs 66.2±9.7 years, P=0.03), ankle reflexes (AR) score (3.42±1.06 vs. 3.04±1.28, P=0.036); among classical risk factors: hypertension [42(79.2%) vs. 117 (61.3%), P=0.015], fibrinogen (4.3±1.11 vs. 3.89±0.88, P=0.02), DM duration (20.2±10.45 vs. 16.96±8.8, P=0.026). However, in multivariable logistic regression analysis it was only IWGDF category 2/3 that remained significantly associated with mortality (OR: 3.78, 95% CI: 1.72–8.28, P=0.001).

Conclusion: This finding underlines the importance of timely diagnosis and management of diabetic foot pathology, especially when we are talking about the intensity of lowering HbA1c. The severity of diabetic foot pathology was a stronger prognostic factor of mortality than cardiovascular risk factors.