Within the aged population, the incidence of diabetes has been gradually increased, and the chronic complications associated with diabetes also increased significantly. DF is one of the serious complications of diabetes. The First Hospital of Jiaxing has a multidisciplinary cooperative treatment team for treating DF. The patients with DF have been well treated and so the numbers of patients with diabetic foot visiting our hospital have been increased greatly. So, we have enough patients in our hospital to provide samples for this study and carry out a lot of research on DF.
The early prevention of DF risk factors is the key to reduce the death and disability of diabetic foot. Our previous studies suggest that homocysteine is a risk factor for DF(Qiang 2016b), but we did not include smoking, history of DF, etc., in previous studies. Recent studies reported that metformin can cause vitamin B12 absorption disorders, vitamin B12 deficiency, folic acid deficiency, and leads to elevated homocysteine level which may aggravate diabetic peripheral neuropathy. On the other hand, metformin administration is believed to improve diabetic peripheral neuropathy by reducing blood sugar level. Diabetic peripheral neuropathy is an important cause of DF (2020), so metformin is worth further exploration. Real and co-workers discussed the relationship between homocysteine and diabetic foot, but did not compare the course of disease, age and sex.(González et al. 2010) The age and course of DF patients are different from that of normal diabetic patients. This study analyzed the risk factors of diabetic foot in male diabetic foot patients, matched the age and course of disease, analyzed the risk factors of diabetic foot, and understood the influencing factors of diabetic foot excluding the factors age, course and sex.
Homocysteine is not only a risk factor for cardiovascular and cerebrovascular diseases(Naveed and Bokhari 2015; Vadini 2019). This study further confirmed that homocysteine is a risk factor for diabetic foot and is in consistent with previous studies(Qiang 2016b). It is believed that homocysteine can lead to endothelial dysfunction.(Austin et al. 2004) It can directly damage and destroy vascular endothelial cells by oxidative stress, promoting lipid peroxidation, inhibiting nitric oxide synthesis, inducing cell necrosis and apoptosis. In addition, it also promotes proliferation of vascular smooth muscle cells, damage platelets and coagulation-fibrinolysis balance, resulting in vascular endothelial damage, accelerate the progress of atherosclerosis and thrombosis. It is believed that homocysteine can lead to arteriosclerosis and occlusion through direct cytotoxicity,(Lahiri et al. 2013; Tripathi 2015) and then cause ischemic and hypoxic injury of nerve, and damage nerve cells directly through endoplasmic reticulum stress(Lehotský et al. 2016). Our study suggests that metformin is not a risk factor for DF and that metformin (OR = 0.851, POR = 0.509) has no direct correlation with diabetic foot. Metformin can cause vitamin B12 deficiency and may affect the metabolism of homocysteine, but the latest study also suggests that metformin treatment can reduce the level of homocysteine(Zhang 2019). Homocysteine is not only affected by drugs, but also associated with abdominal obesity and insulin resistance. Metformin treatment reduces homocysteine by reducing insulin resistance.
This study suggests that smoking history (OR = .1.88, POR = .0.020), previous history of DF disease (OR = .2.290, POR = .0.016) are risk factors for DF and are consistent with current view(2020). Of all the risk factors, the history of DF was the most correlated and the risk was the highest. After the rehabilitation of DF patients, how to prevent the recurrence of DF is particularly important.
This study suggests that hemoglobin is negatively correlated with the occurrence and development of diabetic foot (OR = 0.984, POR = 0.021). Hemoglobin is the protective factor of DF; and anemia is the risk factor of DF. The role of hemoglobin in the occurrence and development of DF cannot be ignored. Hemoglobin is the protein responsible for oxygen transport in the body. Anemia often causes local ischemia and hypoxia, exacerbates the occurrence and development of diabetic foot. Hemoglobin is directly related to the prognosis of DF(Costa 2017).
This study suggested that age (OR = 0.985, P = 0.304), course of disease (OR = 1.048, P = 0.233), HbA1c (OR = 1.302, P = 0.059), LDL-C (OR = 0.936, P = 0.698), creatinine (OR = 1.010, P = 0.326), and ALB (OR = 0.943, P = 0.084) were not significantly correlated with DF. The occurrence of DF is closely related to the poor control(2020) of blood sugar, but our hospital did not suggest that glycosylated hemoglobin is related to DF, and the occurrence is affected by long-term chronic hyperglycemia. Glycosylated hemoglobin represents blood sugar for nearly 2 ~ 3 months.