Impariment of polymorphonuclear leukocyte function and diabetes control in patients with diabetic foot

Track 2. Clinical Research & Care Foot history - 9 pts. with therapeutic footwear at initial vist, 25 pts. had a prior amputation (21 minor and 4 major amputation), 19 pts. had a history of recidival foot ulceration. Duration of the current ulcer was on average 9 months (from 2 weeks to 5 yrs.) until initial visit. Wagner classification of lesions W0 n=9, W 1 n=l l, W 2 n=21, W 3 n=21, W 4 n= 10, W 5 u=l. Severe foot deformities in 39 pts., Charcot lesion in 6 pts. Additional problems: Hyperkeratotic skin in 45 pts., mycotic skin and nails in 25 pts. All pts. had a peripheral neuropathy with abnormal vibration measurement, 24 pts. had peripheral vascular disease (measured by doppler and often additional angiography). Outcome - treatment was required for a mean of 95 days in the outpatient setting, 21 pts. needed additional inpatient therapy. Apart form proper moist would dressings and sufficient wound debridement, we used: oral antibiotics in 32 pts., autologous platelet derived growth factor in 8 pts., biosurgery with Lucilia sericata larvae in 3 pts. 18 pts. needed vascular surgery. 6 pts. required minor amputation, 1 pt. had major amputation. Foot pressure was relieved for all pts. and they received sufficiently adapted footwear after wound closure. 8 pts. had a recidival ulcer within the study period. 5 pts. died mainly from cardiovascular disease. 25 pts. still need active treatment in our foot-care center. Conclusion: Long-term diabetic patients in older age often need specialised foot-care for diabetic foot syndrome. Amputation is rare under intensive treatment (8%). Apart from peripheral neuropathy, the outcome of pts. is often determined by peripheral vascular disease. Therefore intensive peripheral vascular reconstruction is very important.

Pl151 The Life-Long Incidence of Foot Ulcers in an Unselected Diabetes Population in a Norwegian County. Results from the Nord-Tr~ndelag Diabetes Survey S. UHLVING, J.G. Cooper, K. Midthjell, O. Kruger.

Aim: To study the life-long incidence of foot ulcers and problems in a Norwegian diabetes population. Earlier studies have shown that Nord-Tronderlag has one of the highest amputation rates in Norway. Methods: The entire population aged >=20years (92.434) was surveyed between 1995 and 1997 in the Second Nord-Trendelag Health Survey (HUNT 2). The participation rate was 71.3%. The prevalence of known diabetes was 3.22%. The participants answering YES to the question: "Do you have diabetes?" (n= 1972) were asked to complete a new questionnaire about specific foot-problems. 1672(84.8%) answered this questionnaire. Results: Have you ever have foot ulcers requiring 3 weeks or more to heal? YES 158(9.3%), NO 1345(79.5%), no answer 189(11.2%). Age distribution and sex difference will be calculated. Time to heal (weeks): 3-10: 19(14%), 11-30: 12(9%), 31-50: 33(24%), >=51: 71(53%). Condusion: Most other studies of the cumulative incidence of foot ulcers in diabetes populations have been performed on selected (hospital) populations. The strength of this study is that it is a cross-sectional study of the entire adult population in a representative county in Norway. A possible weakness is that the most disabled people may have had difficulties participating in the study. Compared to other studies, few people with diabetes in Nord-Trendelag have serious foot ulcers. We are planning to do further investigations to characterise the people who get foot ulcers. We also want to assess the quality of foot care for the diabetes population and especially those at high risk of getting foot ulcers. Several studies have shown that specialised foot care for people with diabetes, can reduce the burden of foot problems and reduce the amputation rate by more than 50%.

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Pl152 Impairment of Polymorphonuclear Leukocyte Function and Diabetes Control in Patients with Diabetic Foot A. JIRKOVSKA, V. Fejfarovfi, J. Hosov~, J. Kalanin, I. Sff'fL J. Skibov~i. Institute for Clinical and Experimental Medicine, Prague, Czech Republic Bacterial infection requiring prolonged antibiotic therapy is one of the main causes of difficult foot ulcer healing. The purpose of the study was to examine immunologic parameters with respect to polymorphonuclear leukocyte (PMN) functions in patients with chronic bacterial foot infection and their relation to diabetes control. Patients and methods: 19 patients treated over one month for an infected diabetic foot (DF) in our foot clinic (mean age 55 + 10 years and mean duration of diabetes 20-4-9 years, mean HbAlc 8.51-4- 6%) were matched with 20 healthy subjects. Phagocytosis and respiratory burst of PMN were determined by flow cytometry (PHAGOTEST, BURSTTEST; Orpegen Pharma, Heidelberg, ER.G.). HbAlc was assessed by the Bio-Rad DIAMAT system, Bio-Rad laboratories GmbH, Munchen, F.R.G. Results: The patients with DF had significantly less phagocyting PMN in stimulated state compared with the control group (81.8 -4- 10.3 vs. 66.4 -4- 24%, p<0.05). Other parameters of phagocytosis didn't differ between the groups. There was a significant correlation between HbAlc and the percentage of phagocyting PMN in the basal state (r = 0.494, p<0.05). Patients with the highest quartile of HbAlc had significantly more phagocyting PMN in basal state (9.1,4, 5.4%) than patients with the lowest quartile of HbAlc (6.8 -4- 3.6%), p<0.05. No significant differences in PMN respiratory burst in basal and stimulated condition between patients with DF and healthy subjects were found. Conclusions: The results of our study show an impaired phagocyte function reserve in patients with DF and an association of phagocytosis with diabetes control. The lack of increase of PMN respiratory burst in diabetic patients with chronic foot infection could be a sign of decreased killing activity of PMN in these patients. Supported by grant of Ministry of Health IGA No. 5223-3.

Pl153 Screening Test for Diabetic Foot Syndrom - Our Five Years Expirience MILIVOJ PILETIC, Bojana B. Vukelic, Ziva Kavcic. Interni Oddelek, Splosna bolnisnica, Novo mesto, Slovenia Background: The risk for amputation of lower limbs is fifteen times greater in diabetic than in non-diabetic population. To reduce this risk, a comprehensive preventive foot care program started in our diabetic outpatient clinic in 1995. As a part of this program all patients (pts) are screened for risk factors for developing foot pathology, namely: history of foot ulceration and amputation; symptoms of diabetic neuropathy; loss of protective sensitivity, absent pulses and foot deformities. According to findings the pts are classified in risk group 1 (no pathology is found), risk group 2 (insensate for monofilament), risk group 3 (absent pulses), and in risk group 4 for any combination of findings or positive history for amputation/ulceration. Results: From 1.1.1995 to 31. 12. 1999 8363 screening tests were performed on 3441 (F: 1755, M: 1686) pts attending our out-patient clinic. History for amputation was positive in 66 (1,92%) pts; major amputation was performed 25 (0,72%) times. History for ulcers was positive in 111 (3,23%) cases. Deformations were found in 1777 (51,64%) pts, namely: haUux valgus in 223 (6,48%) pts, hammer/claw toes with fat pad atrophy in 1136 (33,01%) pts., callus in 837 (24,32%) pts 1850 (53,76%) were insensate for Semmens-Weinstain monofilament and 235 (6,38%) had absent pulses. According to findings we categorized patients as follows: risk group 1:1488 (43,24%) pts. risk group 2:71 (2,06%) pts, risk group 3:18 (0,52%) pts and in risk group 4 1864 (54,17%) pts. Conclusion: In five years we screened almost 100% of our diabetic population. More than 50% of them are in highest risk group for developing