Endocrine Abstracts

Introduction: With increased incidence of diabetes, more patients with poor glycaemic control risk diabetic foot attack (DFA) - an acute presentation of diabetic foot disease. DFAs are commonly aggravated by an underlying infection on poorly perfused limb, potentially leading to major limb amputations (MLA). Although a surgical issue, early recognition by allied healthcare may reduce incidence and adverse outcomes. This research aims to understand the diabetic and metabolic profile of a DFA cohort.

Methods: Our retrospective cohort of 94 patients admitted to tertiary care at the Queen Elizabeth University Hospital, Glasgow. Biochemical and clinical data were collected using online patient records. Statistical analysis was performed using R.

Results: 94 patients (89.4% male, mean 63.8 years old), 92.6% had type 2 diabetes (T2DM), mean 13 years since diagnosis. 81% had prior documented input from specialist services, podiatry was most common compared to vascular and diabetes. 34.5% of T2DM patients were on oral multi-therapy exclusively, 36.7% on insulin and 14.3% without prior therapy. Average HbA1c was 81.6mmol/mol and admission capillary blood glucose 13.4mmol/l. Mean albumin was 24.9g/l, CRP 142.5mg/l and 27.7% had CKD. 58% had overweight or obese BMI. MLA rate was 35.1% and 30-day mortality 4.1%. Statistical significance for association with MLA was found for albumin (OR 0.81, CI 95% 0.93-1.01) and CRP (OR 1.01, CI 95% 1.00-1.01) at P < 0.05, with near significance for CKD (OR 0.42, CI 95% 0.16-1.06) on a univariate level with only albumin standing at a multivariate level.

Conclusions: Our data highlights acute and chronic metabolic influences on DFA, with albumin as a key indicator. Chronically poor glycaemic control with high insulin dependence is characteristic, and although poor patient compliance remains an issue, the real-world applications of our data illustrate the urgency of identifying high-risk individuals, early tertiary referral, and patient education.