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Impact of microvascular complications on the outcomes of diabetic foot in type 2 diabetic patients with documented peripheral artery disease

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Abstract

Purpose

Microvascular disease (MVD) is associated with amputation linked to peripheral artery disease (PAD) in the general population. No study evaluated the impact of diabetic microvascular complications on the outcomes of vascular diabetic foot ulcers (DFU). The aim of the study was to investigate whether retinopathy, nephropathy, and polyneuropathy can predict the outcomes of DFU in type 2 diabetic patients with PAD.

Methods

Three hundred and thirty-one consecutive patients with vascular DFU were enrolled and followed up for 44.1 ± 23.9 months.

Results

The prevalence of retinopathy was significantly higher in subjects with ulcer persistence (45.2%; p < 0.01), minor amputation (48.9%; p < 0.001), and major amputation (57.9%; p < 0.001) than in healed patients (23.3%), and in non-survivors than in survivors (64.9 versus 20.5%; p < 0.001). The prevalence of nephropathy was significantly greater in subjects with ulcer persistence (83.9%; p < 0.01), minor amputation (86.7%; p < 0.001), and major amputation (94.7%; p < 0.001) than in those with healed DFU (64.4%), and in non-survivors than in survivors (88.3 versus 65.7%; p < 0.001). The prevalence of polyneuropathy was significantly higher in non-survivors than in survivors (76.6 versus 61.0%; p = 0.012). Multivariate analysis showed that absence of retinopathy (OR: 0.451; 95% CI: 0.250–0.815; p < 0.001) and nephropathy (OR: 0.450; 95% CI: 0.212–0.951; p = 0.036) were independently associated with healing. Moreover, retinopathy was a predictor both of minor amputation (OR: 2.291; 95% CI: 1.061–4.949; p = 0.034) and mortality (OR: 5.274; 95% CI: 2.524–11.020; p < 0.001). Polyneuropathy never entered the regression model.

Conclusions

Diabetic microvascular complications, in particular retinopathy, may predict the outcomes of vascular DFU. Longitudinal studies should confirm this finding.

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Authors and Affiliations

  1. Department of Biomedical Sciences for Health, University of Milan, Milan, Italy

    Carmine Gazzaruso, Anna Ferrulli & Livio Luzi

  2. Diabetes and endocrine-metabolic Diseases Unit, Istituto Clinico Beato Matteo, Gruppo Ospedaliero San Donato, Vigevano, Italy

    Carmine Gazzaruso, Pietro Gallotti & Adriana Coppola

  3. Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Catanzaro, Italy

    Tiziana Montalcini & Arturo Pujia

  4. Department of Endocrinology, IRCCS Multimedica, Milan, Italy

    Anna Ferrulli & Livio Luzi

  5. Clinica San Gaudenzio, Gruppo Policlinico di Monza, Novara, Italy

    Cesare Massa Saluzzo

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  1. Carmine Gazzaruso
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Correspondence to Carmine Gazzaruso.

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This study was approved by the local Institutional Review Board.

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This study used information previously collected during normal care (with no intention of using it for research purpose at the time of collection). The data set used was fully anonymized to the authors. Therefore, no informed consent was required from the patients for being included in the study.

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Gazzaruso, C., Montalcini, T., Gallotti, P. et al. Impact of microvascular complications on the outcomes of diabetic foot in type 2 diabetic patients with documented peripheral artery disease. Endocrine 80, 71–78 (2023). https://doi.org/10.1007/s12020-022-03291-6

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