Evaluaton of risc factors for trophic ulcers development in patients with neuropathic diabetic foot

Abstract

Introduction. Neuropathy is the most common long-term complication of diabetes, which affects about 50% of patients. The distal symmetric neuropathy that appears in 75% cases of diabetic neuropathy is one of the main risk factors for developing diabetic foot ulcer. Besides this, there are other important risk factors that could influence the development and the evolution of tisular lesion in a diabetic foot. Aim of the study. Determination of the risk factors and the severity degree of distal neuropathy in patients with diabetic foot ulcers. Materials and methods. Twenty-three patients with neuropathic form of the diabetic foot that had trophic ulcer were included. A number of potential risk factors like the duration of diabetes mellitus, use of insulin therapy, degree of distal neuropathy, poor glycemic control confirmed by HbA1C level, presence of foot deformities, arterial hypertension, and BMI were evaluated. The degree of distal neuropathy was assessed by clinical neuropathy scores: Neuropathy Symptoms Score (NSS) and Neuropathy Disability Score (NDS). Results. The duration of diabetes was more than 5 years in all patients, and 19 patients used insulin. In 94.1% cases NSS was 7-9 points and NDS was 8-10 points that denotes severe neuropathic symptoms. A total of 82.3% patients had poor glycemic control with a level of HbA1C > 8%. 70.5% of patients had foot deformities and in 76.4% cases arterial hypertension was recorded. 94.1% had a BMI > 25 kg/m2, 35.3% were overweight and 58.8% had obesity. Conclusion. Development and progression of trophic ulcers in patients with neuropathic diabetic foot are determined by the distal neuropathy severity degree and are associated with long term diabetes and requirement in insulin therapy. Poor glycemic control, foot deformities, arterial hypertension, overweight and obesity are the risk factors that should be corrected for prophylaxis and successful treatment of skin lesions in patients with diabetic foot.