Criterion validity of metabolic and anthropometric predictors in diabetic foot syndrome

Dragana Bubanja; Zorica Jovanović; Mira  Vuković

doi:10.2298/VSP170418131B

Dragana Bubanja Clinical Center Kragujevac, Center for Endocrinology, Diabetes and Metabolic Diseases, Kragujevac, Serbia
Zorica Jovanović University of Kragujevac, Faculty of Medicine, Institute for Pathophysiology, Kragujevac, Serbia
Mira Vuković General Hospital Valjevo, Education Center, Valjevo, Serbia

DOI: https://doi.org/10.2298/VSP170418131B

Keywords: diabetes mellitus;, diabetic foot;, syndrome; glycated hemoglobin;, body mass index;, prognosis.

Abstract

Background/Aim. The diabetic foot syndrome (DFS) appears in 15% of diabetes mellitus (DM) patients and is the most common cause of hospitalization, prolonged hospital stay and lower extremity amputation. This study assesses the discriminant validity of the indicators of glycemic control, lipoprotein status and the body mass index (BMI) in diagnosing DFS in the DM patients. Methods. A comparative observational study was conducted with the study group composed of patients diagnosed with DM and DFS and a control group, composed of healthy volunteers. Metabolic predictors measured in the study were: fasting glycaemia (FG), postprandial glycaemia (PPG), glycated hemoglobin (HbA1c), total cholesterol, total triglyceride, low density lipoprotein (LDLc) and high density lipoprotein (HDLc). The BMI was measured as an anthropometric variable. The validity criterion of both metabolic and anthropometric variables was estimated by the Receiver Operating Characteristic (ROC) procedure. Results. A total of 70 patients with DM and 60 healthy volunteers were observed. Using the ROC procedure, five significant predictors of DFS were proved. The validity criterion for HbA1c, FG, PPG, LDLc and the BMI were in the following order: 6.3%, 6.3 mmol/L, 7.1 mmol/L, 4.39 mmol/L and 25 kg/m², respectively. Significantly larger surfaces were found under the curve for all glycometabolic variables, compared to the surface under the curve for LDLc, as well as relative to the surface under the curve for BMI. Conclusion. Preventing DFS in patients with DM has to include intensification of diet measures along with the treatment of the increased value of fasting glycaemia, postprandial glycaemia and LDLc, even when they lower compared to the current recommended values for the patients with DM. Lowering body fat in the patients with DM has to be approached in the period of their pre-obesity.

References

American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2013; 36(Suppl 1): S67–74.

Niemann U, Spiliopoulou M, Szczepanski T, Samland F, Grützner J, Senk D, et al. Comparative Clustering of Plantar Pressure Distributions in Diabetics with Polyneuropathy May Be Ap-plied to Reveal Inappropriate Biomechanical Stress. PLoS One 2016; 11(8): e161326.

Logerfo AC. Vascular disease of the lower extremities in diabe-tes mellitus: Etiology and management. In: Kahn CR, Weir GC,‎ King GL,‎ Moses AC,‎ Smith RJ,‎ Jacobson AM, editors. Joslin’s Diabetes mellitus. 14th ed. Philadelphia, PA: Lip-pincott Williams & Wilkins; 2005. p. 1124–31.

Forouzandeh F, Aziz Ahari A, Abolhasani F, Larijani B. Com-parison of different screening tests for detecting diabetic foot neuropathy. Acta Neurol Scand 2005; 112(6): 409–13.

Powers A. Neuropathy and diabetes mellitus. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, editor. Harrison's princi-ple of internal medicine. 17th ed. New York, NY: McGraw-Hill; 2008. p. 2292.

Blakely M. The Use of Best Practice in the Treatment of a Complex Diabetic Foot Ulcer: A Case Report. Healthcare (Basel) 2016; 4(1): pii: E18.

Low P. Pathogenesis of Diabetic Neuropathy. In: Joslin's Dia-betes mellitus', 14th ed. USA: Lippincott Williams & Wilkins. 2005. p. 839–851

Giurini J. The diabetic foot: Strategies for treatment and pre-vention of ulceration. In: Kahn CR, Weir GC,‎ King GL,‎ Moses AC,‎ Smith RJ,‎ Jacobson AM, editors. Joslin's Diabetes mellitus'. 14th ed. Philadelphia, PA:: Lippincott Williams & Wilkins. 2005. p. 1112–21.

Tong P, Cockram G. The epidemiology of type 2 diabetes. In: Pickup JC, Williams G, editors. Text book of Diabetes 1. 3rd ed. Oxford: Blackwell Science; 2003. p. 6.

Siitonen OI, Niskanen LK, Laakso M, Siitonen JT, Pyörälä K. Lower-extremity amputations in diabetic and nondiabetic pa-tients: a population-based study in eastern Finland. Diabetes Care 1993; 16(1): 16–20.

Zubair M, Malik A, Ahmad J. Glycosylated Hemoglobin in Di-abetic Foot and its Correlation with Clinical Variables in a North Indian Tertiary Care Hospital. J Diabetes Metab 2015; 6: 571.

Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): Prospective observational study. BMJ 2000; 321(7258): 405–12.

Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complica-tions in patients with type 2 diabetes (UKPDS 33). UK Pro-spective Diabetes Study (UKPDS) Group. Lancet 1998; 352(9131): 837–53.

World Health Organization. WHO Expert Committee on Diabe-tes Mellitus: Second Report. Geneva: World Health Organiza-tion; 1980.

Christman AL, Selvin E, Margolis DJ, Lazarus GS, Garza LA. Hemoglobin A1c predicts healing rate in diabetic wounds. J Invest Dermatol 2011; 131(10): 2121–7.

Shahbazian H, Yazdanpanah L, Latifi SM. Risk assessment of patients with diabetes for foot ulcers according to risk classifi-cation consensus of International Working Group on Diabetic Foot (IWGDF). Pak J Med Sci 2013; 29(3): 730–4.

Bonner T, Foster M, Spears-Lanoix E. Type 2 diabetes–related foot care knowledge and foot self-care practice interventions in the United States: A systematic review of the literature. Di-abet Foot Ankle 2016; 7: 29758. doi: 10.3402/dfa.v7.29758.

Palta P, Huang ES, Kalyani RR, Golden SH, Yeh H. Hemoglobin A1c and Mortality in Older Adults With and Without Diabe-tes: Results From the National Health and Nutrition Exami-nation Surveys (1988-2011). Diabetes Care 2017; 40(4): 453–60.

American Diabetes Association. 2. Classification and Diagnosis of Diabetes American Diabetes Association. Diabetes Care 2017; 40(Suppl 1): S11–S24.

Nakagami T, Qiao Q, Carstensen B, Nhr-Hansen C, Hu G, Tuomilehto J, et al. DECODE-DECODA Study Group. Age, body mass index and Type 2 diabetes-associations modified by ethnicity. Diabetologia 2003; 46(8): 1063–70.

Muthusamy VV. BR 08-3 Managment of dyslipidemia in hy-pertension. J Hypertens 2016; 34(1): e545.

Al Harbi TJ, Tourkmani AM, Al-Khashan HI, Mishriky AM, Al Qahtani H, Bakhiet A. Adherence to the American Diabetes Association standards of care among patients with type 2 dia-betes in primary care in Saudi Arabia. Saudi Med J 2015; 36(2): 221–7.

Cea-Calvo L, Conthe P, Gómez-Fernández P, de Alvaro F, Fernán-dez-Pérez C. RICARHD investigators . Target organ damage and cardiovascular complications in patients with hyperten-sion and type 2 diabetes in Spain: A cross-sectional study. Cardiovasc Diabetol 2006; 5(1): 23.

Gray N, Picone G, Sloan F, Yashkin A. Relation between BMI and diabetes mellitus and its complications among US older adults. South Med J 2015; 108(1): 29–36.