A Study Of Diabetic Retinopathy In Patients With Diabetic Foot Ulcer Disease

Abstract

AIMS AND OBJECTIVES: The goal of this study was to compare and analyze the grades of Diabetic Foot Ulcer (DFU) with the severity of Diabetic Retinopathy (DR). MATERIAL AND METHODS: A cross-sectional study was carried out on 234 eyes of 117 subjects with various grades of DFU consulting BLDE (Bijapur Lingayat District Educational) (Deemed to be University)’s Shri BM Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, from August 2022 to August 2023. A detailed history was taken, including demographics. Snellen’s visual Acuity, anterior segment examination under slit lamp, mydriatic fundus examination with indirect ophthalmoscopy, and digital fundus photography were performed on all the subjects. DFU grading was done using the “Wagner’s classification system of diabetic foot ulcers”1. Diabetic Retinopathy (DR) grading was based on the Early Treatment Diabetic Retinopathy Study (ETDRS) classification2. Optical Coherence Tomography (OCT) scanning of the macula was performed in all subjects using Spectral Domain- OCT (SD-OCT). Biochemical parameters HbA1C (%), Serum uric acid (mg/dl), Blood urea (mg/dl), Serum creatinine (mg/dl) were all compared against the grade of retinopathy along with the grade of DFU. SPSS (Statistical package for social sciences) software version 20 was used to present descriptive statistics for categorical parameters using frequency and percentage. Mean and standard deviation were used for continuous parametric data. Dependent and independent variables are differentiated using the ANOVA (Analysis of Variance) test.The chi-square test was used to find out the association between the parameters. P value < 0.001 was considered highly statistically significant. RESULTS: The mean age of the patients was 55.63+/- 12.820 years. There were 80 males (68.4%) and 37 females (31.6%). Duration of diabetes mellitus (DM), biochemical parameters like HbA1C (%), Serum Creatinine (mg/dl), Blood Urea (mg/dl), and Serum Uric acid (mg/dl) were all directly proportionate to the severity of retinopathy, which was significant statistically with a P value < 0.001. Comparison of DFU grade with the severity of retinopathy showed a strong positive correlation with a P value < 0.001, which was highly statistically significant. Also, a comparison of DFU grade with OCT measured Central Foveal Thickness (CFT) and Total macular volume, overall average macular thickness showed a strong positive correlation with a P value < 0.001. CONCLUSION: Our study reports a highly statistically significant correlation between the grades of DFU and severity of DR in all the subjects, thus concluding that patients with DFU have a higher risk of DR and vice-versa, pointing the significance of prompt and early screening for these two DM consequences to prevent further serious outcomes.