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Please cite this article in press as Huma Memon et al , Frequency and Outcome of Dyslipidemia in Diabetic
Foot Patients with Type-II Diabetes Mellitus, Indo Am. J. P. Sci, 2017; 4(10).
liaquat University of medical and health science. Majority of the cases were found with abnormal
Results of the lipid profile were assessed lipid profile 55.11%, while 44.89% cases were
according severity of diabetic foot on the basis of found with normal lipid profile. TABLE:3
the Wagners classification. The data was Outcome was assessed according to the
collected on pre-designed Proforma. Data was Wagners classification and majority of the
evaluated in statistical program SPSS version patients were found with Grade I (superficial
16.0. ulcer) 30.61%, following by Grade III (Deep
ulcer with abscess), Grade II (ulcer extension),
RESULTS: Grade V (extensive of gangrene foot) and
Total 196 patients were selected mean age was Grade IV (gangrene of ore foot) were found
found 55.2+4.8 years. Male were found in the with percentage of 21.42%, 19.39%, 12.25% and
majority 65.3% as compare to female. TABLE:1 16.33% respectively. Mortality was not found, it
According to the presenting features in the skin may because extensive gangrenous foot cases of
redness was found most common 71.42%, grade V of this study were referred to
according to pain majority of the cases were orthopaedic department for amputation.
found with pain during walking 57.14%, as well TABLE:4
as weak pulse was noted in 43.88% of the cases.
TABLE:2
Mean +SD = 55.2+4.8 years Range of age was between 40-80 years.
SKIN
Red 140 71.42%
Pallor 70 41.41%
Blue 40 20.40%
Cold/hot 110 56.12%
PAIN
During rest 55 28.07%
During walk 112 57.14%
No pain 29 14.79%
PULSE 90 45.92%
Present 20 10.20%
Absent 86 43.88%
Weak
108 55.11%
88 44.89%
Dyslipidemia
Normolipidemia
DISCUSSION:
Diabetes mellitus increases the risk for In this study cases were found with abnormal
atherosclerotic vascular disease. The risk is lipid profile 55.11%. In an African study, 45%
greatest in people who have other known risk of the patients had their lipid profile assessed at
factors, such as, dyslipidemia, hypertension, least once in a year with only 13% on lipid
smoking and obesity. Patients with diabetes are lowering therapy [15]. In the Diabcare Nigeria
at risk of developing multiple complications study, 48% of the patients were screened for
making their feet vulnerable to damage. This dyslipidemia with low high density lipoprotein
includes triad of neuropathy, ischemia and cholesterol and hypertriglyceridemia being the
infection which interact to cause tissue damage most prevalent lipid abnormalities [16].
which leads to amputation if neglected [11]. Similarly, a low frequency of screening for
Mean age in this series was found as mean+SD dyslipidemia and use of lipid lowering drugs of
55.2+4.8 years, This is similar to most studies 4.9% and 2.7% respectively was reported in one
which have shown diabetic foot to be a problem study done in Ethiopia [17]. However, in another
of the middle aged and the elderly [12,13] study performed in Northern Ethiopia, no cases
Moreover male were found in the majority of hyperlipidemia were found among 105 adult
65.3% with diabetic foot as compare to female diabetic patients [18]. As well as in this study
34.7%. Similarly Shah SF et al [14] reported that dyslipidemia had found TG, TC, HDL-C, LDL-
males were more affected than females (1.12:1). C, VLDL-C, Non HDL-C and TG/H with mean
SD as TG/H 165 109, 185 32, 39 8, 112 Study of Diabetes (EASD). Eur. Heart J.
30, 33 22, 4.55 3.51 and 145 30 2007;28, 88-136.
respectively. 2.Prevention Jarman B, Rae G, Johnson J,
Pickersgrill D, Carter D. Diabetes MellitusAn
Outcome, according to the Wagners update for health care professionals. British
classification majority of the patients were found Medical Association; Feb 2004 [document on
with Grade I (superficial ulcer) 30.61%. While internet]availablefromhttp://www.bma.org.uk/ap.
gangrenous foot ulcers were found 16.33% and nsf/AttachmentsByTitle/PDFDiabetes/$FILE/dia
12.25% as grade VI and V respectively. These betes.pdf.
findings are not very different from those 3.Goldberg IJ. Clinical Review: Diabetic
reported by Doumi E. A et al [19] in Sudan who Dyslipidemia: Causes and Consequences. The
reported 74.1% having Wagner Grade >3. The Journal of Clinical Endocrinology & Metabolism
results were also similar to those by Abbas et al 2001;86;3; 965-971
in MNH [20]. In contrast, in the Seattle Diabetic 4.Mazzone, T., Chait, A, Plutzky, J.
Foot Study in the US, [21] most patients had Cardiovascular disease risk in type 2 diabetes
Grade 1 and 2 Ulcers (66.4%). This reflects most mellitus: insights from mechanistic studies.
of our patients present late, with advanced Lancet 2008;371: 1800-1809.
disease. It could also indicate better foot care and 5.Donal NC, Liu K, Criqui MH. Peripheral
greater awareness on diabetic complications Arterly diseae, diabetes, and reduced lower
among patients in the developed world. As well extremity functioning. Diabetes Care
as 12.25% extensive gangrenous foot cases of 2002;25:11-20.
grade V of this study were referred to 6. Pecoraro RE, Ahroni JH, Boyko EJ, Stensel
orthopaedic department for amputation. Abbas et VL. Chronology and determinants of tissue
al reported that 33% of patients in their study repair in diabetic lower-extremity ulcers.
(i.e. 15.2%) underwent a major amputation [20]. Diabetes. 1991 Oct;40(10):1305-13.
Similarly, Muthuuri et al [22] and Bushra et al 7. Mayfield JA, Reiber GE, Sanders LJ, Janisse
[19] reported amputation rates of 28% and 24.7% D, Pogach LM. preventive foot care in people
respectively. In the UK and the Netherlands, the with diabetes: technical review. Diabetes Care
amputation rates were found to be 15.5% and 21:2161-2177,1998.
16.0% respectively [23,24]. Therefore the 8. Shauowf, Sural N, Abelah: Endovas the
amputation rate in this study was high. This epidemiology and pathophysiology of lower
could be due to the late presentation to hospital extremity by PAD 2006, Feb, 13 Suppl. 2:113-9.
among our patients. In their study at MNH, 9. Norgren L, Hiatt WR, Dormandy JA, Nehler
Abbas et al [20] documented that the reported MR, Harris KA, Fowkes FG, et al. Inter-Society
amputation rate was lower than it should be since Consensus for the Management of Peripheral
most patient didnt give consent for amputation Arterial Disease (TASC II). Eur J Vasc
or requested discharge against medical advice. Endovasc Surg 2007; 33: S1-75. 2.
Mortality had not found in this study. 10. Ali SM, Basit A, Fawwad A, Ahmedani MY,
Miyan Z, Malik RA. Presentation and outcome
CONCLUSION: of diabetic foot at a tertiary care unit. Pak J Med
We concluded that dyslipidemia was 55.11% Sci 2008;24(5):651-56.
and it has an important role in development of 11. Humail SM, Anjum P, Haq SN, Zaidi IH,
severity of diabetic foot. Diabetic patients should Quraishi M A. Disastrous effect of diabetic foot
performed lipid profile for early check of & how this can be prevented. J Pak OrthopAssoc
dyslipidemia to reduce the morbidity and 2009; 21:31-5.
mortality. 12. Nwadiaro HC, Puepet FH, Ike EI, Kidmas
. AT, Nwadiaro PO. Prognostic Indices of
REFERENCES: Diabetic Foot Disease. Nigerian Journal of
1.Rydn L1, Standl E, Bartnik M, Van den Orthopaedic and Trauma 2003; 2(2): 85-89
Berghe G, Betteridge J, de Boer MJ, et al. 13.Ukere AU, Bob-Yellowe E, Dodiyi Manuel
Guidelines on diabetes, pre-diabetes and A. Pattern and Management Approach of
cardiovascular diseases: executive summary. The Diabetic Foot Disease in a Developing country.
Task Force on Diabetes and Cardiovascular Nigerian Journal of Medicine 2005; 14 (3): 272-
Disease of the European Society of Cardiology 275
(ESC) and of the European Association for the 14. Shah SF, Hameed S, Khawaja Z, Abdullah
T. Waqar S H, Evaluation and Management of