Clinical characteristics of patients with diabetic foot using WIfI classification-A pilot study in Vietnam.

BACKGROUND: Due to its effect on patient health and healthcare resources, the study of diabetic foot is essential. Despite the existence of classification and grading systems, further evidence is required. Current systems are prone to a lack of validation in specific populations, inadequate consideration of regional variations, and an incomplete evaluation of risk factors and outcomes. The prevalence and complications of diabetes, such as diabetic foot, are on the rise worldwide, necessitating regionally specific research. To fill these gaps, this study focuses on a Southeast Asian subpopulation. OBJECTIVE: The study aims to evaluate the clinical characteristics of diabetic foot patients using the WIfI classification system, and to develop a risk calculator for patients to predict and evaluate potential outcomes. METHODS: A retrospective analysis was conducted on the medical records of patients with diabetic foot who visited a tertiary hospital in Vietnam between December 2021 and July 2022. Demographic data, clinical characteristics, and outcomes were collected and classified according to the WIfI (Wound, Ischemia, and foot Infection) classification system. Descriptive statistics were used to analyze the data, and a multivariable logistic regression model was employed to develop a risk calculator. RESULTS: The study included 60 patients with diabetic foot. Gender distribution was similar (56.7% male), with a mean age of 44 years. Most patients had ulcers of varying degrees, while ischemia contributed to higher grades, placing 43.3% at moderate-to-high risk of amputation (stages 3 and 4). HbA1c positively correlated with amputation risk (p<0.05), while ABI, TBI, and TP showed inverse correlations (p<0.001). The amputation risk equation based on the WIfI scale was: risk=3.701-0.788ABI-1.260TP. A risk calculator was developed using these predictors to estimate adverse outcomes. CONCLUSION: In diabetic foot patients, early identification and management of risk factors are crucial. The findings of this study highlight the importance of ischemia and its association with amputation risk. Incorporating HbA1c, ABI, and TP, the risk calculator enables personalized assessments of amputation risk, thereby assisting healthcare professionals in treatment planning. Further validation and refinement of the risk calculator is required for broader clinical application.

Prediabetes and insulin resistance in a population of patients with heart failure and reduced or preserved ejection fraction but without diabetes, overweight or hypertension.

BACKGROUND: The relationships between glucose abnormalities, insulin resistance (IR) and heart failure (HF) are unclear, especially regarding to the HF type, i.e., HF with reduced (HFrEF) or preserved (HFpEF) ejection fraction. Overweight, diabetes and hypertension are potential contributors to IR in persons with HF. This study aimed to evaluate the prevalence of prediabetes and IR in a population of Vietnamese patients with HFrEF or HFpEF but no overweight, diabetes or hypertension, in comparison with healthy controls, and the relation between prediabetes or IR and HF severity. METHODS: We conducted a prospective cross-sectional observational study in 190 non-overweight normotensive HF patients (114 with HFrEF and 76 with HFpEF, 92.6% were ischemic HF, mean age was 70.1 years, mean BMI 19.7 kg/m2) without diabetes (neither known diabetes nor newly diagnosed by OGTT) and 95 healthy individuals (controls). Prediabetes was defined using 2006 WHO criteria. Glucose and insulin levels were measured fasting and 2 h after glucose challenge. IR was assessed using HOMA-IR and several other indexes. RESULTS: Compared to controls, HF patients had a higher prevalence of prediabetes (63.2% vs 22.1%) and IR (according to HOMA-IR, 55.3% vs 26.3%), higher HOMA-IR, insulin/glucose ratio after glucose and FIRI, and lower ISIT0 and ISIT120 (< 0.0001 for all comparisons), with no difference for body weight, waist circumference, blood pressure and lipid parameters. Prediabetes was more prevalent (69.3% vs 53.9%, p = 0.03) and HOMA-IR was higher (p < 0.0001) in patients with HFrEF than with HFpEF. Among both HFrEF and HFpEF patients, those with prediabetes or IR had a more severe HF (higher NYHA functional class and NT-proBNP levels, lower ejection fraction; p = 0.04-< 0.0001) than their normoglycemic or non-insulinresistant counterparts, with no difference for blood pressure and lipid parameters. CONCLUSION: In non-diabetic non-overweight normotensive patients with HF, the prevalence of prediabetes is higher with some trend to more severe IR in those with HFrEF than in those with HFpEF. Both prediabetes and IR are associated with a more severe HF. The present data support HF as a culprit for IR. Intervention strategies should be proposed to HF patients with prediabetes aiming to reduce the risk of incident diabetes. Studies should be designed to test whether such strategies may translate into an improvement of further HF-related outcomes.

Acetate wheat starch improving blood glucose response and bilan lipid on obesity dyslipidemia mice

Abstract Resistant starch is particularly concerned with beneficial effects in regulating blood glucose concentration and lipid metabolism, reducing the risk of diabetes and cardiovascular diseases. This study aimed to validate the effects of wheat starch acetate containing 32.1% resistant starch on postprandial blood glucose response and lipid profile on obesity, dyslipidemia Swiss mice induced by a high-fat diet. The result showed that there was a restriction on postprandial hyperglycemia and remained stable for 2 hours after meal efficiently comparing with the control group fed natural wheat starch. Simultaneously, when maintaining the dose of 5g/kg once or twice a day for 8 weeks, wheat starch acetate to be able to reduce body weight and blood glucose, triglyceride, cholesterol levels compared to the control group (p<0.05)