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Characteristics of Plantar Pressure Distribution in Diabetes with or without Diabetic Peripheral Neuropathy and Peripheral Arterial Disease. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2437831. [PMID: 35707567 PMCID: PMC9192305 DOI: 10.1155/2022/2437831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
Abstract
Background. Excessive plantar pressure leads to increased risk of diabetic foot ulcers. Diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD) have been considered to be associated with alterations in gait and plantar pressure in diabetic patients. However, few studies have differentiated the effects with each of them. Objective. To investigate the plantar pressure distribution in diabetic patients, with DPN and PAD as independent or combined factors. Methods. 112 subjects were recruited: 24 diabetic patients with both DPN and PAD (DPN-PAD group), 12 diabetic patients with DPN without PAD (DPN group), 10 diabetic patients with PAD without DPN (PAD group), 23 diabetic patients without DPN or PAD, and 43 nondiabetic healthy controls (HC group). The in-shoe plantar pressure during natural walking was measured. Differences in peak pressure, contact area, proportion of high pressure area (%HP), and anterior/posterior position of centre of pressure (COP) were analysed. Results. Compared with HC group, in DPN-PAD group and DPN group, the peak pressures in all three forefoot regions increased significantly; in PAD group, the peak pressure in lateral forefoot increased significantly. The contact area of midfoot in the DPN-PAD group decreased significantly. PAD group had larger HP% of lateral forefoot, DPN group had larger HP% of inner forefoot, and DPN-PAD group had larger HP% of total plantar area. There was a significant tendency of the anterior displacement of COP in the DPN-PAD group and DPN group. No significant differences were observed between the D group and HC group. Conclusion. DPN or PAD could affect the plantar pressure distribution in diabetic patients independently or synergistically, resulting in increased forefoot pressure and the area at risk of ulcers. DPN has a more pronounced effect on peak pressure than PAD. The synergistic effect of them could significantly reduce the plantar contact area of midfoot.
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Guo F, Zhou T, Tang J, Dong M, Wei Q. Related Risk Factors between Subclinical Carotid Atherosclerosis and Diabetic Retinopathy in Newly Diagnosed Type 2 Diabetes Mellitus in China. Exp Clin Endocrinol Diabetes 2019; 129:283-288. [PMID: 30965364 DOI: 10.1055/a-0865-1754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Abstract
Purpose To analyze the clinical features and related risk factors in diabetic retinopathy (DR) and subclinical atherosclerosis, the micro- and macro-vascular diseases in newly diagnosed type 2 diabetes mellitus (T2DM).
Methods A retrospective study of 435 cases of inpatients with newly diagnosed T2DM from 2013–2017, and compare the 2 types of T2DM related vascular complications.
Results The macro- and microvascular complications are not rare at this stage. Subclinical atherosclerosis was found in 251 subjects (57.7%), which was higher than that of DR (13.1%). In addition, some cases of subclinical atherosclerosis co-existed with DR, suggesting that DR was related with subclinical atherosclerosis (r=0.098, P=0.041). Older age showed a significant association with both subclinical atherosclerosis and DR. Single factor analysis indicated that dyslipidemia was the common risk factor in DR and subclinical atherosclerosis.
Conclusions It should be paid attention to the screening of both DR and subclinical atherosclerosis in each age group of newly diagnosed T2DM. Except for the control of blood glucose, the control of the dyslipidemia is important in the prevention and treatment of the micro- and macro-vascular diseases.
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Affiliation(s)
- Fengqi Guo
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Zhou
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juan Tang
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingxia Dong
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qianping Wei
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Edmonds M. Vascular disease in the lower limb in type 1 diabetes. Cardiovasc Endocrinol Metab 2019; 8:39-46. [PMID: 31646297 PMCID: PMC6739894 DOI: 10.1097/xce.0000000000000168] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/18/2019] [Indexed: 01/13/2023]
Abstract
This review considers peripheral arterial disease (PAD) in the diabetic ischaemic lower limb including both macrovascular and microvascular aspects. The presentation of PAD is probably not significantly different in type 1 compared with type 2 diabetes. PAD in diabetic patients is diffuse and located distally being most severe in the crural and also the foot arteries. It is associated with arterial calcification and occlusion of the arteries rather than stenosis. Compared with the nondiabetic patient, PAD develops at a younger age, and women are equally affected as men. It is not known whether the presentation of ischaemic lower limb disease in diabetes can be explained by one disease, namely, atherosclerosis, which has particular features peculiar to diabetes such as distal arterial involvement, or by the occurrence of two separate diseases: first, classical atherosclerosis and, second, a diabetic macroangiopathy, a term for nonatherosclerotic arterial disease in diabetes that is characterized by medial arterial calcification. Furthermore, there is controversy with regard to the significance of structural changes in the microcirculation of the diabetic foot.
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Kahnert K, Lucke T, Biertz F, Lechner A, Watz H, Alter P, Bals R, Behr J, Holle R, Huber RM, Karrasch S, Stubbe B, Wacker M, Söhler S, Wouters EFM, Vogelmeier C, Jörres RA. Transfer factor for carbon monoxide in patients with COPD and diabetes: results from the German COSYCONET cohort. Respir Res 2017; 18:14. [PMID: 28086884 PMCID: PMC5237203 DOI: 10.1186/s12931-016-0499-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/30/2016] [Indexed: 03/11/2023] Open
Abstract
Background An impairment of CO diffusing capacity has been shown in diabetic patients without lung disease. We analyzed how diffusing capacity in patients with COPD is affected by the concurrent diagnosis of diabetes. Methods Data from the initial visit of the German COPD cohort COSYCONET were used for analysis. 2575 patients with complete lung function data were included, among them 358 defined as diabetics with a reported physician diagnosis of diabetes and/or specific medication. Pairwise comparisons between groups and multivariate regression models were used to identify variables predicting the CO transfer factor (TLCO%pred) and the transfer coefficient (KCO%pred). Results COPD patients with diabetes differed from those without diabetes regarding lung function, anthropometric, clinical and laboratory parameters. Moreover, gender was an important covariate. After correction for lung function, gender and body mass index (BMI), TLCO%pred did not significantly differ between patients with and without diabetes. The results for the transfer coefficient KCO were similar, demonstrating an important role of the confounding factors RV%pred, TLC%pred, ITGV%pred, FEV1%pred, FEV1/FVC, age, packyears, creatinine and BMI. There was not even a tendency towards lower values in diabetes. Conclusion The analysis of data from a COPD cohort showed no significant differences of CO transport parameters between COPD patients with and without diabetes, if BMI, gender and the reduction in lung volumes were taken into account. This result is in contrast to observations in lung-healthy subjects with diabetes and raises the question which factors, among them potential anti-inflammatory effects of anti-diabetes medication are responsible for this finding.
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Affiliation(s)
- Kathrin Kahnert
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany.
| | - Tanja Lucke
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
| | - Frank Biertz
- Institute for Biostatistics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Andreas Lechner
- Department of Internal Medicine IV, University of Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Woehrendamm 80, 22927, Grosshansdorf, Germany
| | - Peter Alter
- Department of Respiratory Medicine, University of Marburg, University Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research, Baldingerstraße, 35043, Marburg, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Rudolf M Huber
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany
| | - Stefan Karrasch
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany.,Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Beate Stubbe
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, Scientific Division of Pneumology and Pneumological Epidemiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - Margarethe Wacker
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Ingolstaedter Landstr. 1, 85764, Neuherberg, Germany
| | - Sandra Söhler
- ASCONET Study Coordination Office, University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands
| | - Claus Vogelmeier
- Department of Respiratory Medicine, University of Marburg, University Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research, Baldingerstraße, 35043, Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
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Papanas N, Tziakas D, Maltezos E, Kekes A, Hatzinikolaou E, Parcharidis G, Louridas G, Hatseras D. IMPACT OF DIABETES MELLITUS ON SEVERITY OF CONCOMITANT PERIPHERAL ARTERIAL OCCLUSIVE DISEASE IN PATIENTS WITH CORONARY ARTERY DISEASE. Acta Clin Belg 2014; 60:129-34. [PMID: 16156372 DOI: 10.1179/acb.2005.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
AIM OF THE STUDY The aim of the study was to evaluate the impact of Diabetes Mellitus (DM) on severity of concomitant Peripheral Arterial Occlusive Disease (PAOD) in patients with Coronary Artery Disease (CAD). PATIENTS AND METHODS This study included 302 patients (229 men) with a mean age of 62.2 +/- 11.5 years who had angiographically documented CAD. Patients were divided into Group I (severe CAD), Group II (moderate CAD) and Group III (mild CAD). Each of the groups I-III was divided into subgroups comprising diabetic patients (subgroups Ia, IIa, IIIa) and non-diabetic patients (subgroups Ib, IIb, IIIb). PAOD was evaluated by measurement of Toe-Brachial Index (TBI). RESULTS PAOD was diagnosed in 69 patients (22.8%). Symptoms of PAOD (intermittent claudication or rest pain) were present in 38 patients (55%), while 31 patients (45%) were asymptomatic. Frequency of symptoms attributable to PAOD did not differ (p = 0.43) between diabetic patients (25 out of 49 patients, 51%) and non-diabetic patients (13 out of 20 patients, 65%). TBI was significantly (p = 0.04) lower in diabetic (0.41 +/- 0.03) than in non-diabetic patients with PAOD (0.51 +/- 0.03). This significant difference was found in each of the Groups I-III. Severity of PAOD was significantly associated with angiographic gravity of CAD, both in diabetic (p = 0.046) and in non-diabetic patients (p = 0.047). CONCLUSIONS DM has an adverse impact on severity of concomitant PAOD in patients with CAD. This impact does not depend on angiographic gravity of CAD. However, the association between severity of PAOD and angiographic gravity of CAD is demonstrated both in diabetic and in non-diabetic patients.
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Affiliation(s)
- N Papanas
- Second Department of Internal Medicine, Democritus University of Thrace, Greece.
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Papanas N, Tziakas D, Mavridis G, Giannakis I, Symeonidis G, Stakos D, Milousis A, Maltezos E, Louridas G, Hatseras D. Aortic arch calcification predicts the extent of coronary atherosclerosis in patients with or without type 2 diabetes: short communication. Acta Clin Belg 2007; 62:52-5. [PMID: 17451146 DOI: 10.1179/acb.2007.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
AIM OF THE STUDY The aim of this study was to evaluate the sensitivity and specificity of aortic arch calcification for detection of severe coronary atherosclerosis in patients suffering from coronary artery disease (CAD), with or without type 2 diabetes. PATIENTS AND METHODS This study included 107 type 2 diabetic patients (68 men) with a mean age of 62.4 +/- 10.7 years and a mean diabetes duration of 14.2 +/- 5.9 years and 104 patients (63 men) with a mean age of 64.5 +/- 9.3 years who did not have diabetes. All patients had CAD, documented by coronary arteriography. Severe CAD was defined as atherosclerosis of the left main branch or atherosclerosis of three coronary arteries or atherosclerosis of the proximal part of the left anterior descending artery. Aortic arch calcification was assessed by means of posteroanterior chest X-rays, studied by a radiologist kept blind to the result of coronary arteriography. RESULTS In type 2 diabetic patients, diagnosis of aortic arch calcification had 65.6% sensitivity and 86.9% specificity for detection of severe CAD. In patients without diabetes, diagnosis of aortic arch calcification had 47.7% sensitivity and 96.7% specificity for detection of severe CAD. CONCLUSIONS Aortic arch calcification has a high specificity for detection of severe coronary atherosclerosis in patients with CAD. Sensitivity is higher in patients with type 2 diabetes, while specificity is slightly higher in non-diabetic patients.
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Affiliation(s)
- N Papanas
- Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
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Papanas N, Tziakas D, Maltezos E, Stakos D, Hatzinikolaou E, Parcharidis G, Louridas G, Hatseras D. Risk factors for concomitant peripheral arterial occlusive disease in patients with coronary artery disease: is there a difference between diabetic and non-diabetic patients? Acta Clin Belg 2005; 60:122-8. [PMID: 16156371 DOI: 10.1179/acb.2005.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
AIM OF THE STUDY The aim of the present study was investigation of cardiovascular risk factors for concomitant Peripheral Arterial Occlusive Disease (PAOD) in diabetic vs. non-diabetic patients with coronary artery disease (CAD). PATIENTS AND METHODS This study included 302 patients (229 men) with a mean age of 62.2 +/- 11.5 years and angiographically documented CAD. These were divided into Group A comprising 116 diabetic patients (79 men) and Group B comprising 186 non-diabetic patients (150 men). Peripheral Arterial Occlusive Disease (PAOD) was diagnosed using a Doppler apparatus. Cardiovascular risk factors that were investigated included age, history of myocardial infarction, smoking, Body-Mass Index, Waist-Hip-Ratio, hypertension and serum lipids. RESULTS PAOD was diagnosed in 49 patients of Group A (42.4%) and 20 patients of Group B (10.8%). In Group A concomitant PAOD was associated with significantly (p = 0.0001) longer diabetes duration and significantly (p = 0.0001) higher frequency of insulin treatment, as well as significantly (p = 0.02) higher triglycerides and significantly (p = 0.039) lower HDL-Cholesterol. In Group B patients with PAOD had significantly (p = 0.0001) higher age and significantly higher (p = 0.041) LDL-Cholesterol levels than those without PAOD. No association was found between PAOD and presence of remaining risk factors in either group. In multiple regression analysis, concomitant PAOD was associated with diabetes duration (p = 0.0026) and insulin treatment (p = 0.0004) in Group A, while it was associated with age (p = 0.01) in Group B. The associations with serum lipids were no longer significant. CONCLUSIONS Among non-diabetic patients with CAD, those who have concomitant PAOD are significantly older. Among diabetic patients with CAD, those who have concomitant PAOD show significantly longer diabetes duration and significantly higher frequency of insulin treatment.
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Affiliation(s)
- N Papanas
- Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
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Milosević Z, Bjekić J, Radulović S, Goldner B. [Clinical significance of intramammary arterial calcifications in women with diabetes mellitus]. VOJNOSANIT PREGL 2004; 61:163-7. [PMID: 15296121 DOI: 10.2298/vsp0402163m] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND It is well known that intramammary arterial calcifications, diagnosed by mammography as a part of generalized diabetic macroangiopathy, may be an indirect sign of diabetes mellitus. Hence, the aim of this study was to determine the incidence of intramammary arterial calcifications, the patient's age when the calcifications occur, as well as to observe the influence of diabetic polyneuropathy, type, and the duration of diabetes on the onset of calcifications, in comparison with nondiabetic women. METHODS Mammographic findings of 113 diabetic female patients (21 with type 1 diabetes and 92 with type 2), as well as of 208 nondiabetic women (the control group) were analyzed in the prospective study. The data about the type of diabetes, its duration, and polyneuropathy were obtained using the questionnaire. Statistical differences were determined by Mann-Whitney test. RESULTS Intramammary arterial calcifications were identified in 33.3% of the women with type 1 diabetes, in 40.2% with type 2, and in 8.2% of the women from the control group, respectively. The differences comparing the women with type 1, as well as type 2 diabetes and the controls were statistically significant (p=0.0001). Women with intramammary arterial calcifications and type 1 diabetes were younger comparing to the control group (median age 52 years, comparing to 67 years of age, p=0.001), while there was no statistically significant difference in age between the women with calcifications and type 2 diabetes (61 years of age) in relation to the control group (p=0.176). The incidence of polineuropathy in diabetic women was higher in the group with intramammary arterial calcifications (52.3%), in comparison to the group without calcifications (26.1%), (p=0.005). The association between intramammary arterial calcifications and the duration of diabetes was not found. CONCLUSION The obtained results supported the theory that intramammary arterial calcifications, detected by mammography, could serve as markers of co-existing diabetes mellitus and therefore should be specified in radiologic report in case of their early development.
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