Piotr Nehring

Diabetic foot risk factors in type 2 diabetes patients: a cross-sectional case control study

BackgroundDiabetic foot is a serious condition in patients with a long lasting diabetes mellitus. Diabetic foot treated improperly may lead not only to delayed ulceration healing, generalized inflammation, unnecessary surgical intervention, but also to the lower limb amputation. The aim of this study was to compare diabetic foot risk factors in population with type 2 diabetes and risk factors for diabetes in healthy subjects.MethodsThe study included 900 subjects: 145 with diabetic foot, 293 with type 2 diabetes without diabetic foot and 462 healthy controls matched in terms of mean age, gender structure and cardiovascular diseases absence. Study was conducted in Gastroenterology and Metabolic Diseases Department, Medical University of Warsaw, Poland. In statistical analysis a logistic regression model, U Mann-Whitney’s and t-Student test were used.ResultsThe binomial logit models analysis showed that the risk of diabetic foot in patients with type 2 diabetes was decreased by patient’s age (odds ratio [OR] = 0.94; 95% confidence interval [CI]: 0.92-0.96; p = 0.00001) and hyperlipidaemia (OR = 0.54; 95% CI: 0.36-0.81; p = 0.01). In contrast, male gender (OR = 2.83; 95% CI: 1.86-4.28; p = 0.00001) diabetes duration (OR = 1.04; 95% CI: 1.03-1.06; p = 0.0003), weight (OR = 1.04; 95% CI: 1.03-1.06; p = 0.00001), height (OR = 1.08; 95% CI: 1.05-1.11; p = 0.00001) and waist circumference (OR = 1.028; 95% CI: 1.007-1.050; p = 0.006) increase the risk of diabetic foot. The onset of type 2 diabetes in healthy subjects was increased by weight (OR = 1.035; 95% CI: 1.024-1.046; p = 0.00001), WC (OR = 1.075; 95% CI: 1.055-1.096; p = 00001), hip circumference (OR = 1.03; 95% CI: 1.01-1.05; p = 0.005), overweight defined with body mass index (BMI) above 24,9 kg/m2 (OR = 2.49; 95% CI: 1.77-3.51; p = 0.00001) and hyperlipidaemia (OR = 3.53; 95% CI: 2.57-4.84; p = 0.00001).ConclusionsRisk factors for Type 2 diabetes and diabetic foot are only partially common. Study proved that patients who are prone to developing diabetic foot experience different risk factors than patients who are at risk of diabetes. Identification of relationship between diabetic foot and diabetes risk factors in appropriate groups may help clinicians to focus on certain factors in diabetic foot prevention.

Risk factors of diabetic foot of neuropathic origin in patients with type 2 diabetes

INTRODUCTION Diabetic foot is a diabetes mellitus complication leading to recurrent ulcerations, risk of osteomyelitis and tissue necrosis which may finally result in amputation. Diabetic foot of neuropathic origin manifesting as autonomic and sensory motor neuropathy is the most common type of this complication. The aim of this study was to identify risk factors of diabetic foot of neuropathic origin occurrence in patients with type 2 diabetes. MATERIAL AND METHODS The study included 240 patients, 74 with diabetic foot of neuropathic origin and 166 with diabetes. Cases and controls were matched in terms of age structure. Patients with peripheral arterial disease were excluded from the study. The study was conducted in the Gastroenterology and Metabolic Diseases Department, Medical University of Warsaw, Poland. We used logistic regression models, χ2, U Mann-Whitneys and t-Student tests. RESULTS Logistic regression analysis showed that diabetic foot of neuropathic origin risk factors were: male gender (OR = 6.63; 95% CI: 3.31-13.27; p = 0.00001), duration of diabetes (OR = 1.10; 95% CI: 1.06-1.14; p = 0.00001), height (OR = 1.09; 95% CI: 1.06-1.13; p = 0.00001), weight (OR = 1.04; 95% CI: 1.04-1.06; p = 0.00001) and waist circumference (OR = 1.05; 95% CI: 1.02-1.08; p = 0.001). Although there was a correlation between diabetic foot of neuropathic origin and BMI value, it had no impact on DF occurrence risk. CONCLUSION It is possible to identify patients at risk of diabetic foot development by evaluating anthropometric features. The existence of specific factors increasing the odds of diabetic foot of neuropathic origin occurring may lead to the identification of patients at risk of its development.

Zenker's diverticulum: aetiopathogenesis, symptoms and diagnosis. Comparison of operative methods

Zenker’s diverticulum is an alimentary tract pouch localized in the area of the upper esophageal sphincter. Treatment procedure complications and coexisting diseases constitute a serious diagnostic and therapeutic problem. Characteristic symptoms and signs facilitate differential diagnosis, simultaneously being real patient maladies. There are many treatment procedures leading to pouch septum reduction and decrease of upper esophageal sphincter pressure. After years of experience in operating and endoscopic treatments we found it necessary to compare these different methods.

Risk factors of charcot neuroarthropathy development in patients with type 2 diabetes.

AIM Charcot neuroarthropathy is a very rare form of diabetic foot syndrome occurring among others in patients with diabetes mellitus. Charcot neuroarthropathy leads to bone tissue destruction and may result in foot amputation. The aim of the study was to identify risk factors of Charcot neuroarthropathy occurrence in patients with diabetic foot and type 2 diabetes. MATERIALS The study included 144 patients with type 2 diabetes; 33 with Charcot neuroarthropathy and 111 with diabetic foot of neuropathic origin without neuroarthropathy. The study was perform in Gastroenterology and Metabolic Diseases Department, Medical University of Warsaw, Poland. RESULTS The regression analysis showed that Charcot neuroarthropathy occurrence risk factors were: male gender (OR=4.94, 95% CI:1.63-15.03, p=0.003), age (OR=0.92, 95% CI:0.87-0.96, p=0.0001), diabetic foot duration (OR=1.19, 95% CI:1.08-1.32, p=0.00002) and height (OR=1.078, 95% CI:1.019-1.140, p=0.007). A positive effect on Charcot neuroarthropathy presence was exerted by body weight (OR=1.027, 95% CI:1.003-1.051, p=0.03) and hips circumference (OR=1.034, 95% CI:0.997-1.072, p=0.04). CONCLUSIONS The existence of the specific factors influencing Charcot neuroarthropathy development may result in earlier identification of patients at risk of its development. There is a necessity to take special care for patients prone to develop Charcot neuroarthropathy in order to prevent its occurrence and severe complications.

The MDR1/ABCB1 gene rs 1045642 polymorphism in colorectal cancer

Introduction Colorectal cancer (CRC) is one of the most frequently diagnosed tumors in Western countries. CRC is a heterogeneous group of tumors with regards to its molecular pathogenesis and genetic factors. Both genetic variations and anthropometric factors may affect morbidity in CRC patients. The aim of this study was to assess the impact of multidrug resistance 1/ATP-binding cassette sub-family B member 1 gene (MDR1/ABCB1) polymorphism rs1045642 and general anthropometric factors on the CRC risk. Material and methods The study included 250 patients who underwent colonoscopy and polypectomy between 2006 and 2013 in a single endoscopy unit in Warsaw, Poland. Results The CRC was diagnosed in 50 individuals, and 200 patients were included in the control group. Cases and controls were matched for mean age and sex (p > 0.05). Factors that were found to significantly increase the risk of CRC were ulcerative colitis (8/35 in the CRC group vs. 8/181 in the control group; p = 0.001), family history of CRC (11/33 vs. 26/172; p = 0.05), and diabetes mellitus (12/34 vs. 28/170; p = 0.04). Allele T of the rs 1045642 polymorphism was more frequently present in CRC cases (in both a co-dominant and recessive model) and in males (in a co-dominant model), although these associations were not statistically significant (p > 0.05). Conclusions The MDR1/ABCB1 gene polymorphism rs 1045642 may be involved in the pathogenesis of CRC and this relationship may be sex-specific for males. However, further population studies are necessary to assess this relationship.