Title: Association between Diabetic Foot Ulcer and Diabetic Retinopathy

Authors: Dr Kangujam Satyabati Devi, Dr K.M Suresh, Dr Santhalayam Sivankunju Deeja

 DOI: https://dx.doi.org/10.18535/jmscr/v11i6.19

Abstract

Diabetes mellitus is a metabolic disorder with disturbance in carbohydrate, protein and fat metabolism because of partial or complete deficiency of insulin secretion or action. As it can cause various complications and Diabetic retinopathy being the most common and perhaps the most serious of all ocular complications. Diabetic foot ulcer is one of the most serious and disabling complications of diabetes mellitus which result in significantly elevated morbidity and mortality. Aim of the study was to assess the severity of diabetic retinopathy in relation to various grades of diabetic foot ulcer among 100 patients with clinically diagnosed type 2 Diabetes Mellitus with diabetic foot ulcer patients. 25% of the study participants were found to have Moderate NPDR with 15% of the study participants having severe NPDR. 11.1% of study participants with grade 4 DFU had PDR with HRC and 33.3% of study participants with grade 4 DFU had Severe NPDR. 47.1% and 35.3% of study participants with grade 3 DFU had Severe NPDR and moderate NPDR respectively. The association was found to be statistically significant between the severity of diabetic retinopathy and the grades of diabetic foot ulcer of the study participants. The study concluded that the severity of diabetic retinopathy increases with the increase in the stages of DFU and there is a possibility that the presence of DFU can predict the progression to advanced stages of DR. The results of our study support the need for a system of ophthalmological referral in case of detection of DFU, as well as a prompt referral of DR patients to a DFU specialist. Also, in advanced age DFU patients, and particularly those with longer duration of diabetes, early detection of DR and timely treatment may decrease the risk of severe vision loss or blindness.

Keywords: diabetic foot ulcer, diabetic retinopathy, risk factors, severity, India.

References

  1. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2006 Jan;29 Suppl1:S43-48.
  2. Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Physical Therapy [Internet]. 2008 Nov 1 [cited 2022 Sep 20];88(11):1254–64. Available from: https://academic.oup.com/ptj/article/88/11/1254/2858146
  3. Antonetti DA, Klein R, Gardner TW. Diabetic retinopathy. N Engl J Med [Internet]. 2012 Mar 29 [cited 2022 Sep 20];366(13):1227–39. Available from: http://www.nejm.org/doi/10.1056/NEJMra1005073
  4. Duh EJ, Sun JK, Stitt AW. Diabetic retinopathy: current understanding, mechanisms, and treatment strategies. JCI Insight [Internet]. 2017 Jul 20 [cited 2022 Sep 20];2(14):e93751. Available from: https://insight.jci.org/articles/view/93751
  5. Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet. 2010 Jul 10;376(9735):124–36. 

  6. Yau JWY, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012 Mar;35(3):556–64.
  7. Stefánsson E, Bek T, Porta M, Larsen N, Kristinsson JK, Agardh E. Screening and prevention of diabetic blindness. Acta Ophthalmol Scand. 2000 Aug;78(4):374–85.
  8. Lightman S, Towler HM. Diabetic retinopathy. Clin Cornerstone. 2003;5(2):12–21.
  9. Tong L, Vernon SA, Kiel W, Sung V, Orr GM. Association of macular involvement with proliferative retinopathy in Type 2 diabetes. Diabet Med. 2001 May;18(5):388–94.
  10. Mottl AK, Pajewski N, Fonseca V, Ismail-Beigi F, Chew E, Ambrosius WT, et al. The degree of retinopathy is equally predictive for renal and macrovascular outcomes in the ACCORD Trial. J Diabetes Complications. 2014 Dec;28(6):874–9.
  11. Kawasaki R, Tanaka S, Tanaka S, Abe S, Sone H, Yokote K, et al. Risk of cardiovascular diseases is increased even with mild diabetic retinopathy: the Japan Diabetes Complications Study. Ophthalmology. 2013 Mar;120(3):574– 82.
  12. Thomas RL, Dunstan FD, Luzio SD, Chowdhury SR, North RV, Hale SL, et al. Prevalence of diabetic retinopathy within a national diabetic retinopathy screening service. Br J Ophthalmol [Internet]. 2015 Jan [cited 2022 Sep 20];99(1):64–8. Available from: https://bjo.bmj.com/lookup/doi/10.1136/bjophthalmol-2013-304017
  13. Apelqvist J, Larsson J. What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes Metab Res Rev [Internet]. 2000 Sep [cited 2022 Sep 20];16(S1):S75–83. Available from: https://onlinelibrary.wiley.com/doi/10.1002/1520- 7560(200009/10)16:1+<::AID-DMRR139>3.0.CO;2-8
  14. Prompers L, Schaper N, Apelqvist J, Edmonds M, Jude E, Mauricio D, et al. Prediction of outcome in individuals with diabetic foot ulcers: focus on the 
differences between individuals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia. 2008 May;51(5):747–55.
  15. Yazdanpanah L, Shahbazian H, Nazari I, Arti HR, Ahmadi F, Mohammadianinejad SE, et al. Incidence and risk factors of diabetic foot ulcer: a population-based diabetic foot cohort (Adfc study)—two-year follow- up study. International Journal of Endocrinology [Internet]. 2018 [cited 2022 Sep 20];2018:1–9. Available from: https://www.hindawi.com/journals/ije/2018/7631659/
  16. Hwang DJ, Lee KM, Park MS, Choi S hee, Park JI, Cho JH, et al. Association between diabetic foot ulcer and diabetic retinopathy. Bjornstad P, editor. PLoS ONE [Internet]. 2017 Apr 7 [cited 2022 Sep 20];12(4):e0175270. Available from: https://dx.plos.org/10.1371/journal.pone.0175270
  17. Dòria M, Rosado V, Pacheco LR, Hernández M, Betriu À, Valls J, et al. Prevalence of diabetic foot disease in patients with diabetes mellitus under renal replacement therapy in lleida, spain. BioMed Research International [Internet]. 2016 [cited 2022 Sep 20];2016:1–8. Available from: http://www.hindawi.com/journals/bmri/2016/7217586/
  18. Prevalence of diabetic retinopathy in Iran: a systematic review and Meta- analysis. Int J Ophthalmol [Internet]. 2017 May 18 [cited 2022 Sep 20]; Available from: http://www.ijo.cn/gjyken/ch/reader/view_abstract.aspx?file_no=20170521&fl ag=1
  19. Karam T, Kamath Y, Rao L, Rao K, Shenoy S, Bhandary S. Diabetic retinopathy in patients with diabetic foot syndrome in South India. Indian J Ophthalmol [Internet]. 2018 [cited 2022 Sep 20];66(4):547. Available from: https://journals.lww.com/10.4103/ijo.IJO_1000_17
  20. Vaishnavi R, Ansu Ann John, Ponniah Iyyapan, Mary Thomas. Study on association of diabetic foot ulcer with diabetic retinopathy in a university teaching hospital. International journal of scientific research [Internet]. 2020 Jun;9(6):6–8. Available from: https://www.worldwidejournals.com/international-journal-of-scientific- research-(IJSR)/recent_issues_pdf/2020/June/study-on-association-of- diabetic-foot-ulcer-with-diabetic-retinopathy-in-a-university-teachinghospital_June_2020_1591092996_2717185.pdf

Corresponding Author

Dr Kangujam Satyabati Devi

Junior Resident, Department of Ophthalmology, Rajarajeswari Medical College and Hospital 202, Mysore Road, Kengeri Satellite Town, Kambipura, Karnataka 560074