Risk factors for diabetic foot ulcers in metreleptin naïve patients with lipodystrophy

Clinical Diabetes and Endocrinology

EA Oral¹  S Kaya²  M Sonmez Ince³  A Balci⁴  C Altay⁴  O Saydam⁵  H Bilen⁶  FE Keskin⁷  F Bayraktar⁸  B Ozgen Saydam⁸  SC Adiyaman⁸  B Akinci⁹  MA Eren^1,10  M Dagdeviren^1,11  G Akinci^1,12 

[1] Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology and Diabetes, University of Michigan, 1000 Wall Street, 48105, Ann Arbor, MI, USA;Department of Internal Medicine, Gulhane Training and Research Hospital, Ankara, Turkey;Department of Internal Medicine, William Beaumont Royal Oak Hospital, Royal Oak, MI, USA;Department of Radiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey;Division of Cardiovascular Surgery, Izmir Tepecik Training and Research Hospital, Izmir, Turkey;Division of Endocrinology and Metabolism, Ataturk University Training and Research Hospital, Erzurum, Turkey;Division of Endocrinology and Metabolism, Demiroglu Bilim University Faculty of Medicine, Istanbul, Turkey;Division of Endocrinology and Metabolism, Dokuz Eylul University Faculty of Medicine, Inciralti, Izmir, Turkey;Division of Endocrinology and Metabolism, Dokuz Eylul University Faculty of Medicine, Inciralti, Izmir, Turkey;Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology and Diabetes, University of Michigan, 1000 Wall Street, 48105, Ann Arbor, MI, USA;Division of Endocrinology and Metabolism, Harran University Faculty of Medicine, Sanliurfa, Turkey;Division of Endocrinology and Metabolism, Kecioren Training and Research Hospital, Ankara, Turkey;Division of Pediatric Neurology, Behcet Uz Children’s Hospital, Izmir, Turkey;Department of Neurology, University of Michigan, Ann Arbor, MI, USA;

关键词: Diabetes;    Foot ulcer;    Lipodystrophy;    Neuropathy;    Peripheral artery disease;   

DOI  :  10.1186/s40842-021-00132-9

来源: Springer

【 摘 要 】

AimPatients with lipodystrophy are at high risk for chronic complications of diabetes. Recently, we have reported 18 diabetic foot ulcer episodes in 9 subjects with lipodystrophy. This current study aims to determine risk factors associated with foot ulcer development in this rare disease population.MethodsNinety metreleptin naïve patients with diabetes registered in our national lipodystrophy database were included in this observational retrospective cohort study (9 with and 81 without foot ulcers).ResultsPatients with lipodystrophy developing foot ulcers had longer diabetes duration (p = 0.007), longer time since lipodystrophy diagnosis (p = 0.008), and higher HbA1c levels (p = 0.041). Insulin use was more prevalent (p = 0.003). The time from diagnosis of diabetes to first foot ulcer was shorter for patients with generalized lipodystrophy compared to partial lipodystrophy (p = 0.036). Retinopathy (p < 0.001), neuropathy (p < 0.001), peripheral artery disease (p = 0.001), and kidney failure (p = 0.003) were more commonly detected in patients with foot ulcers. Patients with foot ulcers tended to have lower leptin levels (p = 0.052). Multiple logistic regression estimated significant associations between foot ulcers and generalized lipodystrophy (OR: 40.81, 95% CI: 3.31–503.93, p = 0.004), long-term diabetes (≥ 15 years; OR: 27.07, 95% CI: 2.97–246.39, p = 0.003), and decreased eGFR (OR: 13.35, 95% CI: 1.96–90.67, p = 0.008).ConclusionsOur study identified several clinical factors associated with foot ulceration among patients with lipodystrophy and diabetes. Preventive measures and effective treatment of metabolic consequences of lipodystrophy are essential to prevent the occurrence of foot ulcers in these high-risk individuals.

【 授权许可】

CC BY