RELATIONSHIP BETWEEN SERUM FETUIN –A LEVELS AND DEVELOPMENT OF DIABETIC FOOT

Abstract

Diabetes is a group of chronic diseases characterized by hyperglycemia, which has direct and indirect effects on the human vascular tree and are the major source of morbidity and mortality in both type 1 and type 2diabetes. Generally, the injurious effects of hyperglycemia are separated into macrovascular complications (coronary artery disease, peripheral arterial disease, and stroke) and microvascular complications (diabetic nephropathy, neuropathy, and retinopathy). One of the most important complications of diabetes mellitus is neuropathy and diabetic foot. Manifestations of resulting complications range from simple to highly complex, including limb amputations and life–threatening infections. The WHO defined the diabetic foot as a ‘group of syndromes in which tissue breakdown occurs because of neuropathy, ischemia and/or infection. Peripheral neuropathy causes loss of sensation and autonomic dysfunction. Fetuin-A is a glycoprotein formed by liver cells and secreted into the serum in high concentration, several studies have demonstrated that it is increased in insulin resistance and that it is an independent predictor of type-2 diabetes. The aim of this study is to investigate the possible relationship between serum fetuin-A levels and the development of diabetic foot lesions. The present study was conducted on 90 Subjects,Cases were grouped as follow: Group 1: Thirty cases diagnosed as type II diabetic patients with diabetic foot complications Group 2: Thirty cases diagnosed as type II diabetic patients without diabetic foot complications. Group 3: Thirty healthy control persons. The age of studied population ranged from 18 to 60 years. Regarding sex distribution in our study groups, males were more than females, in group 1 and group 2 were 20/10 and in group 3 were 18/12. In the current studyTypeoffoot lesion (66.7%) had diabetic foot ulcer(10 cases were neuropathic ulcer,4 cases were ischaemic ulcer and 6 cases were neuropathic and ischaemic). (13.3%) had Charcot foot(4 cases) while among the total number of the diabetic patients with diabetic foot lesion (20.0%) had mixed lesion. Serum fetuinA in group 1 was 2.43 ± 0.88g/l and in group 2 was 1.26 ± 0.43g/l while in group 3 was 0.41 ± 0.21g/l. Cases diabetic foot lesions showed highly statistical significance regarding HbA1c andSerum HDL when compared with the control group p<0.001,while serum cholesterol, serum TAG and serum LDL showeda significant difference p< 0.05. Diabetes duration was longer in group 1 than in group 2 and there was no difference between both groups regarding BMI and smokin. Group 1 showed a significantly higher mean blood pressure compared to both Group 2 and 3.