Association between diabetic foot ulcer and diabetic retinopathy

Duck Jin Hwang; Kyoung Min Lee; Moon Seok Park; Sung Hee Choi; Ji In Park; Joon Hee Cho; Kyu Hyung Park; Se Joon Woo

doi:10.1371/journal.pone.0175270

Association between diabetic foot ulcer and diabetic retinopathy

PLoS One. 2017 Apr 7;12(4):e0175270. doi: 10.1371/journal.pone.0175270. eCollection 2017.

Authors

Duck Jin Hwang^{1

2}, Kyoung Min Lee³, Moon Seok Park³, Sung Hee Choi⁴, Ji In Park⁵, Joon Hee Cho⁶, Kyu Hyung Park^{1

7}, Se Joon Woo¹

Affiliations

¹ Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.
² Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea.
³ Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
⁴ Department of Endocrinology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
⁵ Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea.
⁶ Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
⁷ Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.

Abstract

Purpose: We aimed to investigate the prevalence of diabetic retinopathy (DR) in patients with diabetic foot ulcer (DFU) and elucidate the association between DR and DFU severities and their shared risk factors.

Methods: A retrospective review was conducted on DFU patients who underwent ophthalmic and vascular examinations within 6 months; 100 type 2 diabetic patients with DFU were included. The medical records of 2496 type 2 diabetic patients without DFU served as control data. DR prevalence and severity were assessed in DFU patients. DFU patients were compared with the control group regarding each clinical variable. Additionally, DFU patients were divided into two groups according to DR severity and compared.

Results: Out of 100 DFU patients, 90 patients (90%) had DR and 55 (55%) had proliferative DR (PDR). There was no significant association between DR and DFU severities (R = 0.034, p = 0.734). A multivariable analysis comparing type 2 diabetic patients with and without DFUs showed that the presence of DR [OR, 226.12; 95% confidence interval (CI), 58.07-880.49; p < 0.001] and proliferative DR [OR, 306.27; 95% CI, 64.35-1457.80; p < 0.001), higher HbA1c (%, OR, 1.97, 95% CI, 1.46-2.67; p < 0.001), higher serum creatinine (mg/dL, OR, 1.62, 95% CI, 1.06-2.50; p = 0.027), older age (years, OR, 1.12; 95% CI, 1.06-1.17; p < 0.001), higher pulse pressure (mmHg, OR, 1.03; 95% CI, 1.00-1.06; p = 0.025), lower cholesterol (mg/dL, OR, 0.94; 95% CI, 0.92-0.97; p < 0.001), lower BMI (kg/m2, OR, 0.87, 95% CI, 0.75-1.00; p = 0.044) and lower hematocrit (%, OR, 0.80, 95% CI, 0.74-0.87; p < 0.001) were associated with DFUs. In a subgroup analysis of DFU patients, the PDR group had a longer duration of diabetes mellitus, higher serum BUN, and higher serum creatinine than the non-PDR group. In the multivariable analysis, only higher serum creatinine was associated with PDR in DFU patients (OR, 1.37; 95% CI, 1.05-1.78; p = 0.021).

Conclusions: Diabetic retinopathy is prevalent in patients with DFU and about half of DFU patients had PDR. No significant association was found in terms of the severity of these two diabetic complications. To prevent blindness, patients with DFU, and especially those with high serum creatinine, should undergo retinal examinations for timely PDR diagnosis and management.

MeSH terms

Adult
Aged
Aged, 80 and over
Ankle Brachial Index
Diabetic Foot / complications*
Diabetic Retinopathy / complications*
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Retrospective Studies
Severity of Illness Index

Grants and funding

This work was supported by the National Research Foundation of Korea (NRF) grant 2016R1D1A1B03934724 funded by the Korean government (MSIP). The funding organization had no role in the design or conduct of this research.