Diabetic foot syndrome: a relevant growth factor

The role of different growth factors in both micro and macroangiopathic complications of diabetes had not been explored enough. One of the most relevant growth factor in diabetic foot syndrome patients [DFU] is the vascular endothelial growth factor [VEGF]. Some therapeutic trials has been started based on the hypothesis that administration of VEGF will lead to stimulation of angiogenesis and increased collaterals both in peripheral arterial disease [PAD] and coronary artery disease [CAD] specially in inoperable patients. To study plasma VEOF levels in diabetic patients and its relation to PAD in the different subtype of Diabetic foot ulcer whether isehemic, neuropathic or neuroischemic. Sixty nine patients with type 2 diabetes were recruited into this study; 38 had DFU and 31 patients without foot ulceration [diabetic group], together with 24 healthy subjects of matched age and sex as a control group.Ankle brachial pressure was assessed by Doppler ultrasound. The diagnosis of peripheral neuropathy was based on complete neurological assessment of both lower limbs with special stress on pressure perception evaluated by using 10 gram monnfllament [5.07 SW monofilament]. Angiography examination of lower limb vessels was done. Plasma level of VEGF was estimated. Serum VEOF was significantly increased in DFIJ patients and in patients with ischemic ulcers. The increase was more pronounced in latter than the former group. The elevated plasma VEOF levels are unlikely to be explained by other confounding variables such as variability in metabolic control, concomitant retinopathy or increased urinary albumin excretion. Whether the high plasma levels of VEGF could affect clinical outcome or have an impact on response to therapy as it is the case in patients with acute coronary syndrome will definitely merit further studies

Study of some risk factors in diabetic foot ulcer patients

Objectives: To study plasma homocysteine and lipoprotein [a] levels together with sum other conventional tisk factors for atherosclerosis in diabetic foot ulcer [DFU] patients in comparism to diabetic palicnts without foot ulceration

Subjects and Methods: The study included 66 patients with type 2 diabetes [37 with DFU and 29 without DFU] and 20 healthy normal subjects of matched age and sex. DFU patients were classified into neuropathic, ischemic or neuroischemic ulcer according to neuropathy disability score. Plasma levels of total homocysteine [tHcy] was measured by enzyme immunoassay while lipoprotein [a] was measured by immunoturbidimetric method. Serum folic acid and vitamin BIZ were measured by radioimmunoassay

Results: Fasting plasma homocysteine and lipoprotein [a] levels were elevated in diabetic patients compared to the control subjects. DFU patients had significantly higher levels of tHcy and Lp[a] in comparison to non-DFU patients. Serum folate was lower in diabetic patients in comparison to the control subjects. DFU patients had significantly lower levels of folic acid in comparison to non-DFU patients. Serum levels of vitamin BIZ showed non significant changes in DFU, non-DFU and control subjects. Urinary albumin excretion [UAE] was significantly higher in the DFU patients in comparison to non-DFU patients. Homocysteine concentration showed significant positive correlation with UAE and Lp[a] and significant negative correlation with serum folic acid

Conclusion: DFU patients had higher levels of homocysteine and lipoprotein [a] and lower levels of folic acid in comparison to diabetic patients without DFU. Hyperhomocysteinemia and hyperlipoproteinemia [a] may partially explain the increased risk of macrovascular complications in DFU patients