Exploring the Link Between Neuropathy and Foot Ulcers in Diabetes Mellitus Patients
Abstract
Introduction: This study examines middle-aged individuals (mean age 56.4 years) with type 2 diabetes mellitus (T2DM) and diabetic foot ulcers (DFU), focusing on demographic factors and their links to complications. Chronic hyperglycemia and genetic predisposition significantly contribute to disease progression.
Aim: The study aims to assess baseline characteristics, evaluate neuropathy severity using the Michigan Neuropathy Screening Instrument (MNSI), investigate autonomic dysfunction, and explore correlations between these factors.
Method: A cohort of 300 participants was evaluated for demographic and clinical variables, including MNSI scores, Wagner ulcer classification, and autonomic function tests such as heart rate variability (HRV), Valsalva ratio, postural hypotension, heart rate response to deep breathing, and sympathetic skin response. Pearson’s correlation coefficients were calculated to analyze variable relationships.
Results: Participants exhibited moderate neuropathy (mean MNSI score: 7.2) and predominantly Grade 2 or 3 ulcers (60%). Autonomic tests revealed reduced HRV (30.2), impaired Valsalva ratio (1.21), diminished parasympathetic activity (heart rate response: 14.5), and widespread sympathetic dysfunction (95%). Significant correlations included: advanced age with higher MNSI scores (p < 0.05), prolonged diabetes duration with higher Wagner grades (p < 0.05), and reduced HRV and parasympathetic activity with higher MNSI scores (p < 0.01).
Conclusion: The interplay between demographic factors, clinical variables, and autonomic dysfunction influences neuropathy and DFU severity in T2DM. Targeted interventions are essential for managing complications and improving diabetic foot care.
How to cite this article:
Naganandini R. Exploring the Link Between Neuropathy and Foot Ulcers in Diabetes Mellitus Patients. Chettinad Health City Med J. 2024;13(4):96-102.
DOI: https://doi.org/10.24321/2278.2044.202465
References
Armstrong DG, Boulton AJ, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367-75. [PubMed] [Google Scholar]
Ministry of Health and Family Welfare, Government of India. National Health Policy. Government of India; 2017.
Boulton AJ, Armstrong DG, Albert SF, Frykberg RG, Hellman R, Kirkman MS, Lavery LA, Lemaster JW, Mills Sr JL, Mueller MJ, Sheehan P, Wukich DK; American Diabetes Association; American Association of Clinical Endocrinologists. Comprehensive foot examination and risk assessment: a report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008;31(8):1679-85. [PubMed] [Google Scholar]
Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet. 2003;361(9368):1545-51. [PubMed] [Google Scholar]
International Diabetes Federation. IDF Diabetes Atlas. 9th ed. Brussels, Belgium: International Diabetes Federation; 2019. p. 34-5.
Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217-28. [PubMed] [Google Scholar]
Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention; 2020.
Vinik AI, Maser RE, Ziegler D. Autonomic imbalance: prophet of doom or scope for hope? Diabet Med. 2003;20(6):368-81. [Google Scholar]
American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2021. Diabetes Care. 2021 Jan;44(Suppl 1):S15-33. [PubMed] [Google Scholar]
Apelqvist J, Larsson J. What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes Metab Res Rev. 2000;16(S1):S75-83. [PubMed] [Google Scholar]
Frykberg RG, Armstrong DG, Giurini J, Edwards A, Kravette M, Kravitz S, Ross C, Stavosky J, Stuck R, Vanore J; American College of Foot and Ankle Surgeons. Diabetic foot disorders: a clinical practice guideline. American College of Foot and Ankle Surgeons. J Foot Ankle Surg. 2000;39(5 Suppl):S1-60. [PubMed]
Lavery LA, Armstrong DG, Wunderlich RP, Mohler MJ, Wendel CS, Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29(6):1288-93. [PubMed] [Google Scholar]
Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM; American Diabetes Association. Preventive foot care in diabetes. Diabetes Care. 2004;27 Suppl 1:S63-4. [PubMed] [Google Scholar]
Mueller MJ, Sinacore DR, Hastings MK, Strube MJ, Johnson JE. Effect of Achilles tendon lengthening on neuropathic plantar ulcers: a randomized clinical trial. J Bone Joint Surg Am. 2003;85(8):1436-45. [PubMed] [Google Scholar]
Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation: basis for prevention. Diabetes Care. 1990;13(5):513-21. [PubMed] [Google Scholar]
Prompers L, Schaper N, Apelqvist J, Edmonds M, Jude E, Mauricio D, Uccioli L, Urbancic V, Bakker K, Holstei P, Jirkovska A, Piaggesi A, Ragnarson-Tennvall G, Reike H, Spraul M, Van Acker K, Van Baal J, Van Merode F, Ferreira I, Huijberts M. 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;51(5):747-55. [PubMed] [Google Scholar]
Reiber GE, Vileikyte L, Boyko EJ, del Aguila M, Smith DG, Lavery LA, Boulton AJ. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care. 1999;22(1):157-62. [PubMed] [Google Scholar]
Reiber GE. The epidemiology of diabetic foot problems. Diabet Med. 1996;13(S1):S6-11. [PubMed] [Google Scholar]
Schaper NC, Apelqvist J, Bakker K. The international consensus and practical guidelines on the management and prevention of the diabetic foot. Curr Diab Rep. 2003;3(6):475-9. [PubMed] [Google Scholar]
Sheehan P, Jones P, Caselli A, Giurini JM, Veves A. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial. Diabetes Care. 2003;26(6):1879-82. [PubMed] [Google Scholar]
Smith DG, Boone DA, Taylor KB. The effects of ankle position on the diagnosis of peripheral arterial disease in diabetic patients. J Bone Joint Surg. 1997;79(3):400-1.
Tentolouris N, Al-Sabbagh S, Walker MG, Boulton AJ, Jude EB. Mortality in diabetic and nondiabetic patients after amputations performed from 1990 to 1995: a 5-year follow-up study. Diabetes Care. 2004 Jul;27(7):1598-604. [PubMed] [Google Scholar]
Vileikyte L, Rubin RR, Leventhal H. Psychological aspects of diabetic neuropathic foot complications: an overview. Diabetes Metab Res Rev. 2004 May-Jun;20(Suppl 1):S13-8. [PubMed] [Google Scholar]
Zgonis T, Stapleton JJ, Girard-Powell VA, Hagino RT. Surgical management of diabetic foot infections and amputations. AORN J. 2008 May;87(5):935-46. [PubMed] [Google Scholar]
Ziegler D, Rathmann W, Dickhaus T, Meisinger C, Mielck A; KORA Study Group. Prevalence of polyneuropathy in pre-diabetes and diabetes is associated with abdominal obesity and macroangiopathy: the MONICA/KORA Augsburg Surveys S2 and S3. Diabetes Care. 2008;31(3):464-9. [PubMed] [Google Scholar]
Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives. Nat Rev Endocrinol. 2012;8(4):228-36. [PubMed] [Google Scholar]
