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Coronary artery disease as an independent predictor of survival in patients with type 2 diabetes and Charcot neuro-osteoarthropathy

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Abstract

Aims

Charcot neuro-osteoarthropathy (CN) is a rare complication of diabetic foot syndrome associated with chronic inflammation of the foot and severe, limb-threatening musculoskeletal deformities. Aim of this study was to investigate patients with CN for comorbidities, amputations, ulcers, secondary diseases and mortality.

Methods

The study was conducted at a specialized German hospital for patients with diabetes. One-hundred and eleven patients were enrolled, and their course was followed over a period of 15 years. Association of CN with comorbidity, foot ulcers, amputations and mortality was assessed. Clinical course of patients was followed using two standardized questionnaires.

Results

Presence of CN was significantly associated with diabetic retinopathy (p = 0.047), plantar (p < 0.001), tarsal (p = 0.032) and middle-foot ulcers (p = 0.01). A significant correlation between the presence of CN and a history of amputations was seen (p = 0.022). Patients were at increased risk to suffer from subsequent amputations during follow-up when micro- and macrovascular comorbidities such as retinopathy (p = 0.01) and peripheral artery disease (p < 0.001) were present. Additionally, coronary artery disease (CHD) was identified as an independent predictor of mortality in the cohort of this study (OR 6.192, 95 % CI 1.155–33.208, p = 0.033). Median overall survival of patients with CN and CHD was significantly shorter than OS of patients without CHD (7.8 vs. 13.1 years, p = 0.0045, HR 2.8437, 95 % CI 0.9818–8.2364).

Conclusions

In our study, CHD was the most important factor of survival in CN patients. For optimal management of CN, adequate diagnostics and treatment of CHD according to current guidelines should be considered.

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Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed consent

Informed consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations

  1. Division of Endocrinology and Diabetes, Department of Internal Medicine 1, Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany

    Dominik Bergis

  2. Research Institute Diabetes Academy Mergentheim (FIDAM), Theodor-Klotzbuecher-Strasse 12, 97980, Bad Mergentheim, Germany

    Pia Maria Bergis, Norbert Hermanns, Karl Zink & Thomas Haak

  3. University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany

    Norbert Hermanns

  4. Diabetes Center Mergentheim, Theodor-Klotzbuecher-Strasse 12, 97980, Bad Mergentheim, Germany

    Norbert Hermanns, Karl Zink & Thomas Haak

Authors
  1. Dominik Bergis
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  2. Pia Maria Bergis
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Correspondence to Dominik Bergis.

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Bergis, D., Bergis, P.M., Hermanns, N. et al. Coronary artery disease as an independent predictor of survival in patients with type 2 diabetes and Charcot neuro-osteoarthropathy. Acta Diabetol 51, 1041–1048 (2014). https://doi.org/10.1007/s00592-014-0669-9

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  • DOI: https://doi.org/10.1007/s00592-014-0669-9

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