Endocrine Abstracts

JOINT4012

Diabetic foot is a term used to describe the foot of a patient suffering from diabetes who is at potential risk of several pathological consequences, including infection, ulceration, and/or destruction of deep tissues associated with neurological abnormalities, varying degrees of peripheral vascular disease, and/or metabolic complications of diabetes in the lower extremity. A diabetic ulcer is a critical and central event of the cascade of diabetic foot. A 42-year-old female patient was admitted as an emergency in November 2020 with ketoacidosis (pH 6.9) with impaired consciousness, glucose on admission 38.3 mmol/l, HbA1c 14.01%, CRP 429.98 mg/l, negative for COVID. Anamnestic data indicate that over the past 2 years, she has gradually started to lose more than 12 kg of body weight, especially during the last 5-6 months, when she noticed the blisters on her heels that began to spread. Also, she has experienced the absence of menstrual cycles for 7-8 months. She denies previous illnesses and is a non-smoker. On physical examination, body weight was 56 kg, height 1.78 m, and BMI 17.7 kg/m², ulcer on the right heel and a deep, ulcerative change on the left heel and exposed region in the area of the left Achilles tendon, and hypotrophy of the muscles of both the upper and lower extremities. Hormonal analyses showed the values of thyroid hormones, cortisol, and PTH within the reference range, FSH 0.66 mIU/l, LH 0.18 mIU/l, estradiol 54 pmol/l, progesterone <0.3 mmol/l. Immunological analyses showed IA At 2.5 IU/ml within the reference range, highly positive GAD-65At 749.3 IU/ml, and antiTPO positive at 10.35 IU/ml. The echo-Doppler of the lower extremity blood vessels was normal, as was the X-ray of the bones of the feet. The neurological examination showed bilateral sensorimotor polyneuropathy, and the ophthalmological examination showed non-proliferative diabetic retinopathy, and the cataract in the right eye. Upon admission, intensified insulin therapy with human insulin analogues was introduced and excellent glycoregulation was achieved. A multidisciplinary approach was applied in the treatment of diabetic foot, with ulcer treatment by a surgeon, neurological therapy, and regular follow-up and hyperbaric oxygen therapy for 6 months. The ulcerative changes were completely healed after 5 months with no recurrence during the previous 4 years of follow-up\. Studies have shown that early recognition of LADA and strict glycaemic control is the key to improving the prognosis for LADA and reducing the risk of developing complications.