Analysis of Risk Factors Responsible for Neuropathy in Patients with Type 2 Diabetes Mellitus with Diabetic Foot during the COVID 19 Pandemic

Heri Kristianto

Abstract


Background: Neuropathy in diabetic foot is the onset of diabetic foot complications. The COVID‑19 pandemic has caused changes in the health service system. The lockdown decision can make it difficult for patients to get medication and consult with health workers due to physical activity restrictions. This research aimed to analyze the factors that contribute to peripheral neuropathy in diabetic foot during the COVID‑19 pandemic.

 Materials and Methods: The research is a cross‑sectional study with a sample of 122 patients with type 2 diabetes mellitus who participated in the Chronic Disease Management Program at community health centers in Malang, Indonesia, and was selected using a purposive sampling method. Data were analyzed using multivariate linear regression.

Results: Variables that contributed to the development of neuropathy were ankle‑brachial index of the right foot (β = 7.35, p = 0.06), irregular exercise (β = 2.01, p = 0.07), glycated hemoglobin A (HbA1c) (β = 0.97, p < 0.001), and Low‑Density Lipoprotein (LDL) (β = 0.02, p = 0.06). Meanwhile, the variables that contributed to reducing neuropathy were ankle‑brachial index of the left foot (β = −1.62, p = 0.73) and being female (β = −2.62, p = 0.02). The regression model could explain the variation in the scores of neuropathy in diabetic foot during the COVID‑19 pandemic (R2 = 20.10%).

Conclusion: The factors that contributed to the incidence of neuropathy in diabetic foot during the COVID‑19 pandemic were ankle‑brachial index, exercise for diabetes, LDL, HbA1c, and sex.



Keywords


Ankle brachial index, COVID‑19, diabetic neuropathies, exercise, glycated hemoglobin low density lipoprotein

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References


Nouhjah S, Jahanfar S. Challenges of diabetes care management in developing countries with a high incidence of COVID 19: A brief report. Diabetes Metab Syndr 2020;14:731 2.

Kumar A, Arora A, Sharma P. Effect of lockdown on the glycemic control of diabetes patients. Diabetes Metab Syndr

;14:447 8.

Rastogi A, Hiteshi P, Bhansali A. Improved glycemic control amongst people with long standing diabetes during COVID 19 lockdown: A prospective, observational, nested cohort study. Int J Diabetes Dev Ctries 2020;40:476 81.

Banerjee M, Chakraborty S, Pal R. Diabetes self management amid COVID 19 pandemic. Diabetes Metab Syndr 2020;14:351 4.

Pal R, Bhadada SK. COVID 19 and diabetes mellitus: An unholy interaction of two pandemics. Diabetes Metab Syndr 2020;14:513 7.

Jaly I, Iyengar K, Bahl S, Hughes T, Vaishya R. Redefining diabetic foot disease management service during COVID 19 pandemic. Diabetes Metab Syndr 2020;14:833 8.

Papanas N, Papachristou S. COVID 19 and diabetic foot: Will the lamp burn bright? Int J Low Extrem Wounds 2020;19:111.

Odriozola A, Ortega L, Martinez L, Odriozola S, Torrens A, Corroleu D, et al. Widespread sensory neuropathy in diabetic patients hospitalized with severe COVID 19 infection. Diabetes Res Clin Pract 2021;172:108631.

Rastogi A, Hiteshi P, Bhansali AA, Jude EB. Virtual triage and outcomes of diabetic foot complications during Covid 19 pandemic: A retro prospective, observational cohort study. PLoS One 2021;16:e0251143.

Aan de Stegge WB, Mejaiti N, van Netten JJ, Dijkgraaf MGW, van Baal JG, Busch Westbroek TE, et al. The cost effectiveness and cost utility of at home infrared temperature monitoring in reducing the incidence of foot ulcer recurrence in patients with diabetes (DIATEMP): Study protocol for a randomized controlled trial. Trials 2018;19: 520.

Clarys P, Barel AO. Measurement of skin surface hydration. In Agache's Measuring the Skin, F. Fanian, P. Humbert, H. Maibach (eds). Vrije Universiteit Brussel. 2017, p. 143 7.

Dinsdale G, Moore T, O’Leary N, Tresadern P, Berks M, Roberts C, et al. Intra and inter observer reliability of nailfold videocapillaroscopy — A possible outcome measure for systemic sclerosis related microangiopathy. Microvasc Res 2017;112:1 6.

Hsu P C, Liao P Y, Chang H H, Chiang JY, Huang Y C, Lo L C. Nailfold capillary abnormalities are associated with type 2 diabetes progression and correlated with peripheral neuropathy. Medicine (Baltimore) 2016;95:e5714.

Mufti A, Coutts P, Sibbald RG. Validation of commercially available infrared thermometers for measuring skin surface temperature associated with deep and surrounding wound infection. AdvSkin Wound Care 2015;28:11 6.

Tomy A, Alexander TA, Joseph P. Accuracy of vibration test and monofilament examination against biothesiometer test for the identification of diabetic peripheral neuropathy among diabetic patients. Int J Innov Res Adv Stud 2021;8:21 5.

Latha MM, Yella S. Investigating the use of biothesiometer for detecting the severity of diabetic neuropathy in diabetic type II patients. J Med Sci Clin Res 2017;5:28806 12.

Zografou I, Iliadis F, Sambanis C, Didangelos T. Validation of neuropad in the assessment of peripheral diabetic neuropathy in patients with diabetes mellitus versus the Michigan neuropathy screening instrument, 10 g monofilament application and biothesiometer measurement. Curr Vasc Pharmacol 2020;18:517 22.

Saraswathi R. Comparison of standard outpatient screening tools and nerve conduction studies for the diagnosis of diabetic peripheral neuropathy: A pilot study, in physical medicine and rehabilitation.Christian Medical College, Vellore; 2017.

Assaad Khalil SH, Zaki A, Rehim AA, Megallaa MH, Gaber N,Gamal H, et al. Prevalence of diabetic foot disorders and related risk factors among Egyptian subjects with diabetes. Prim Care Diabetes 2015;9:297 303.

Salvotelli L, Stoico V, Perrone F, Cacciatori V, Negri C, Brangani C, et al. Prevalence of neuropathy in type 2 diabetic patients and its association with other diabetes complications: The verona diabetic foot screening program. J Diabetes Complications 2015;29:1066 70.

Roerecke M, Kaczorowski J, Myers MG. Comparing automated office blood pressure readings with other methods of blood pressure measurement for identifying patients with possible hypertension: A systematic review and meta analysis. JAMA Intern Med 2019;179:351 62.

Lai Y R, Chiu W C, Huang C C, Tsai N W, Wang H C, Lin W C, et al. HbA1C variability is strongly associated with the severity of peripheral neuropathy in patients with type 2 diabetes. Front Neurosci 2019;13:90.

Su J B, Zhao L H, Zhang X L, Cai H L, Huang H Y, Xu F, et al. HbA1c variability and diabetic peripheral neuropathy in type 2 diabetic patients. Cardiovascu Diabetol 2018;17:47.

Eleftheriadou I, Tentolouris A, Grigoropoulou P, Tsilingiris D, Anastasiou I, Kokkinos A, et al. The association of diabetic microvascular and macrovascular disease with cutaneous circulation in patients with type 2 diabetes mellitus. J Diabetes Complications 2019;33:165 70.

Weller CD, Team V, Ivory JD, Crawford K, Gethin G. ABPI reporting and compression recommendations in global clinical practice guidelines on venous leg ulcer management: A scoping review. Int Wound J 2019;16:406 19.

van Doremalen RF, van Netten JJ, van Baal JG, Vollenbroek Hutten MM, van der Heijden F. Infrared 3D thermography for inflammation detection in diabetic foot disease: A proof of concept. J Diabetes Sci Technol 2020;14:46 54.

Maldonado G, Guerrero R, Paredes C, Ríos C. Nailfold capillaroscopy in diabetes mellitus. Microvasc Res 2017;112:41 6.

Melese H, Alamer A, Temesgen MH, Kahsay G. Effectiveness of exercise therapy on gait function in diabetic peripheral neuropathy patients: A systematic review of randomized controlled trials. Diabetes Metab Syndr Obes 2020;13:2753 64.

Hicks CW, Selvin E. Epidemiology of peripheral neuropathy and lower extremity disease in diabetes. Curr Diab Rep 2019;19:86.

Priyo S. Analisis Data Bidang Kesehatan. Penerbit: Raja Grafindo Persada. Jakarta; 2016.

Troisi N, Turini F, Chisci E, Ercolini L, Frosini P, Lombardi R, et al. Impact of pedal arch patency on tissue loss and time to healing in diabetic patients with foot wounds undergoing infrainguinal endovascular revascularization. Korean J Radiol 2018;19:47 53.

Fiogbé E, de Vassimon Barroso V, de Medeiros Takahashi AC. Exercise training in older adults, what effects on muscle oxygenation? A systematic review. Arch Gerontol Geriatr 2017;71:89 98.

Golledge J, Singh T, Alahakoon C, Pinchbeck J, Yip L, Moxon J, et al. Meta analysis of clinical trials examining the benefit of structured home exercise in patients with peripheral artery disease. Br J Surg 2019;106:319 31.

Ellul C, Formosa C, Gatt A. Effects of intermittent calf muscle electrical stimulation on walking capacity in claudicants living with type 2 diabetes. J Am Podiatr Med Assoc 2020;110:1 7. doi: 10.7547/17 046.

Świątoniowska N, Sarzyńska K, Szymańska Chabowska A, Jankowska Polańska B. The role of education in type 2 diabetes treatment. Diabetes Res Clin Pract 2019;151:237 46.

Lee EC, Kim MO, Roh GH, Hong SE. Effects of exercise on neuropathy in streptozotocin induced diabetic rats. Ann Rehabil Med 2017;41:402 12.

Jenkins DW, Jenks A. Exercise and diabetes: a narrative review. J Foot Ankle Surg 2017;56:968 74.

Matos M, Mendes R, Silva AB, Sousa N. Physical activity and exercise on diabetic foot related outcomes: A systematic review. Diabetes Res Clin Pract 2018;139:81 90.

Liu X, Xu Y, An M, Zeng Q. The risk factors for diabetic peripheral neuropathy: A meta analysis. PLoS One 2019;14:e0212574.

Ghosal S, Sinha B, Majumder M, Misra A. Estimation of effects of nationwide lockdown for containing coronavirus infection on worsening of glycosylated haemoglobin and increase in diabetes related complications: A simulation model using multivariate regression analysis. Diabetes Metab Syndr 2020;14:319 23.

Myers A, Presswala L, Bissoonauth A, Gulati N, Zhang M, Izard S, et al. Telemedicine for disparity patients with diabetes: The feasibility of utilizing telehealth in the management of uncontrolled type 2 diabetes in black and hispanic disparity patients: A pilot study. J Diabetes Sci Technol 2020;15:1 8.

Watkins S, Neubrander J. Primary care registered nurse telehealth policy implications. J Telemed Telecare 2020;28:1 4.

Pai Y W, Lin C H, Lee I T, Chang M H. Prevalence and biochemical risk factors of diabetic peripheral neuropathy with or without neuropathic pain in Taiwanese adults with type 2 diabetes mellitus. Diabetes Metab Syndr 2018;12:111 6.

Savelieff MG, Callaghan BC, Feldman EL. The emerging role of dyslipidemia in diabetic microvascular complications. Curr Opin Endocrinol Diabetes Obes 2020;27:115 23.

Shetty V, Jain H, Singh G, Parekh S, Shetty S. Ankle brachial pressure index correlation with diastolic blood pressure, dyslipidemia and anthropometric measurement in patients of essential hypertension. Hypertension 2017;35:39.

Wang Y, Xu D. Effects of aerobic exercise on lipids and lipoproteins. Lipids Health Dis 2017;16:132.

Darivemula S, Nagoor K, Patan SK, Reddy NB, Deepthi CS, Chittooru CS. Prevalence and its associated determinants of diabetic peripheral neuropathy (DPN) in individuals having type 2 diabetes mellitus in rural South India. Indian J Community Med 2019;44:88 91.

Ghosal S, Arora B, Dutta K, Ghosh A, Sinha B, Misra A. Increase in the risk of type 2 diabetes during lockdown for the COVID19 pandemic in India: A cohort analysis. Diabetes Metab Syndr 2020;14:949 52.

Ruiz Roso MB, Knott Torcal C, Matilla Escalante DC, Garcimartín A, Sampedro Nuñez MA, Dávalos A, et al. COVID 19 lockdown and changes of the dietary pattern and physical activity habits in a cohort of patients with type 2 diabetes mellitus. Nutrients 2020;12:2327.


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