ISSN 1849-9031 (Online)

ISSN 1849-8922    (Print)

Patients with type 2 diabetes mellitus and diabetic nephropathy have higher risk for foot ulceration.
Irfan Ahmeti, Ivana Mladenovska, Iskra Bitovska, Sasha Jovanovska Misevska, Igor Nikolov, Nadica Bozhinovska, Tatjana Milenkovic.


Background and Aims: The primary aim of this study was to analyze the association between renal parameters and the risk for the presence of diabetic foot by using the International Working Group on the Diabetic Foot (IWGDF) classification in patients with type 2 diabetes mellitus (T2DM).

Subjects and Methods: We conducted a prospective, cross-sectional study, which included 107 consecutive hospitalized patients with T2DM, aged 35-65 years, over the 6-month period. Patients were examined and tested for diabetic foot and classified according to the IWGDF into four groups. The presence of kidney disease was assessed based on clinical practice guideline for diabetes and chronic kidney disease and classified into grades [1-5] based on the estimated glomerular filtration rate (eGFR) calculated with Cockcroft-Gault and modification of diet in renal disease formula. The patterns of proteinuria were assessed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis.

Results: Only 4 (3.7%) patients were classified into risk 0 group, 65 (60.7) into risk group 1, 22 (20.6%) into risk group 2 and 16 (15.0%) of patients were classified into risk group 3. Patients in risk group 2 and 3 had significantly higher serum creatinine level, lower eGFR, higher proportion of grade 4 renal insufficiency, type 4 proteinuria and higher rate of proliferative diabetic retinopathy. Serum creatinine showed the highest predictive accuracy in detecting patients at high risk for diabetic foot (area under the curve 0.769, 95% confidence interval 0.674-0.864) (Figure 2). Serum creatinine >143 μmol/L had a 95% specificity and serum creatinine >67 μmol/L had 95% specificity.

Conclusion: Patients with T2DM at high risk for diabetic foot syndrome have significantly impaired renal function, without the significant differences in other anthropometric and metabolic parameters. Simple serum creatinine measurement may be useful for detecting high-risk patients.