medwireNews: Several well characterized complications of diabetes, such as retinopathy, may help identify individuals with type 1 or type 2 diabetes at particular risk for developing Charcot foot disease, Swedish researchers say.
Charcot osteoarthropathy is an inflammatory condition affecting the soft tissue and bones of the foot and ankle that can result in deformity and amputation, explain Sergiu-Bogdan Catrina (Karolinska Institutet, Stockholm) and co-workers in Diabetologia.
While Charcot foot has previously been linked to peripheral neuropathy, minor trauma, ulceration, infection, and surgery, the team now reports that “distinctive and common risk factors” associated with diabetes also play a role in the development of Charcot foot in patients with type 1 or type 2 diabetes.
The researchers matched data for 3397 adults with diabetes and Charcot foot included in two nationwide Swedish registries to that of 27,662 participants with a similar diabetes duration but no Charcot foot disease.
Among patients with Charcot foot, those with type 1 diabetes had a lower age on average than their counterparts with type 2 diabetes, a longer duration of diabetes, a higher glycated hemoglobin level, and a higher rate of retinopathy. However, they also had a lower BMI, lower systolic and diastolic blood pressure, and fewer episodes of ischemia and atherosclerosis.
The investigators also note that while the majority of Charcot foot patients with type 2 diabetes were men (68.1%), there was an even split between women and men among those with type 1 diabetes (50.4 and 49.6%, respectively).
When compared with individuals with type 1 diabetes without Charcot foot, affected people with type 1 diabetes were more likely to have retinopathy (63.4 vs 36.5%), microalbuminuria (27.7 vs 12.2%), macroalbuminuria (21.3 vs 6.9%), a history of atherosclerosis (6.8 vs 1.5%), and a higher HbA1c (68 vs 64 mmol/mol; 8.4 vs 8.0%).
This pattern was also found among people with type 2 diabetes and Charcot foot compared with those without, say Catrina et al.
Logistic regression analysis, assessing for a range of confounding factors for each biomarker, confirmed that pre-existing microvascular complications and atherosclerosis were the strongest predictors of Charcot foot in both patients with type 1 and type 2 diabetes.
Specifically, people with type 1 and type 2 diabetes were significantly more likely to develop Charcot foot if they had macroalbuminuria (odds ratio [OR]=3.12 and 2.54, respectively), microalbuminuria (OR=2.31 and 1.89), retinopathy (OR=4.10 and 2.66), or atherosclerosis (OR=3.32 and 8.60). There were also small but significantly increased risks with longer duration of diabetes and increasing HbA1c.
The team concludes that monitoring these risk factors for Charcot foot in adults with type 1 or type 2 diabetes could help early diagnosis and treatment of affected individuals.
“Similar studies in other populations are warranted to determine the generalisability of these results,” the authors note.
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