Should we be giving an anti inflammatory to our patients with foot ulcers? #diabetes #ada2012

Authors: MOHAMMAD ZUBAIR, ABIDA MALIK, JAMAL AHMADAligarhIndia
Abstract: Pro-and-anti-inflammatory processes are crucial in different phases of wound healing and its disturbances interfere with tissue homeostasis after the manifestation of ulcers leading to chronic non-healing wounds. However, data on the association between inflammation and acute foot syndrome are scarce. Circulating levels of acute-phase reactant and cytokines were measured in diabetic patients with an ulcer (n=162) and without ulcer (n=162) in a case-control study. Every subject with diabetic foot was matched for age, sex and BMI. Of the patients, 85.1% had type 2 diabetes. Subjects with diabetic foot ulcer showed lower median plasma level of adiponectin [8.4(7.1-9.2) vs 13.4(12.1-14.2)] ng/ml, higher median plasma levels of IL-6 [32.5(9.4-44.8) vs 6.7(4.6-14.6)] ng/ml, hsCRP [12.6(11.2-13.6) vs 8.4(7.1-9.2)] mg/ml and TNF-α [99.4(79.9-121.5) vs 4.9(4.5-5.6)] ng/ml. A positive correlation was found between BMI and retinopathy for adiponectins, for IL-6, between grades of ulcer, BMI, LDL-C, triglycerides, retinopathy, nephropathy & smoking, for hsCRP: grades of ulcer, BMI, LDL-C, triglycerides, retinopathy, nephropathy & smoking, while total cholesterol and neuropathyfor TNF-α. This study demonstrates that diabetic subjects with various grades of diabetic foot ulcer showed a higher plasma IL-6, hsCRP, TNF-α and lower adiponectin levels in comparison with diabetes without foot ulcer independent of the concomitant infections. It would be interesting to find out whether an activation of immune system precedes the development of foot ulcer and whether anti-inflammatory therapies will be effective in improving the outcome in such patients

What do you think?
These data again highlight the importance of “measuring what we manage” in our units. Development of theragnostics and diagnostics may well assist us in this endeavor.

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