The master’s thesis at the College of Medicine, Karbala University, discussed diabetes, which is the main cause of death worldwide.
Diabetes leads to many complications such as diabetic foot syndrome, which is caused by neuropathy and ischemia.
Approximately 15% of diabetic patients suffer from complications of the diabetic foot, which leads to high rates of morbidity and mortality among people with diabetes. 25% of people with diabetic foot are at risk of lower limb amputation due to poor wound healing. Previous studies revealed that the immune response and inflammatory processes play an important role in the pathogenesis of diabetes mellitus.
The total number of participants in the study was 193; They were divided into three groups: the first group included patients with type 1 diabetes (29 with diabetic foot ulcers + 35 without diabetic foot ulcers), the second group included patients with type 2 diabetes (41 with diabetic foot ulcers + 38 without diabetic foot ulcers). The third group includes (50) as a group subject to health control
Laboratory tests were also performed for all by serological technique (ELISA), and were used to determine the levels of IL-37, IL-38, and IL17A in the serum.
Also, swabs were taken from patients with diabetic foot ulcers to conduct a bacteriological examination for aerobic bacteria using different techniques, and then using the Vitec device to determine the bacterial species present in the infection area.
The results of the current study showed that there were statistically significant differences between the three studied groups with regard to age and duration of diabetes. There were also highly significant differences in FBS, HBA1c, cholesterol, HDL, LDL and triglycerides. In addition, there were significant differences in the levels of CRP, PLT, Lymphocytes, Neutrophil and ESR among the three studied groups. On the other hand, the results showed that there were no statistically significant differences in the levels of Hb and WBCs.
The present study showed that the levels of IL-37 and IL-17A were statistically high (p < 0.01) in all diabetic patients under study as compared to the control group. While the results showed that the levels of IL-38 were significant in patients with type 1 and type 2 diabetes, compared with healthy subjects. In addition, the DFU group in T2DM demonstrated elevated levels of IL-37, IL-38, and IL-17A compared to the other diabetic groups.
As for the results of the bacteriological examination of the swabs taken from the infected foot, the highest incidence of diabetic foot ulcers occurred in patients between the ages of (50-59) years. Of the 70 samples collected, 67 were positive for microbial growth and 3 samples showed no growth. Of the 67 microbial culture-positive samples, monomicrobial infection was found in 29 patients, and polymicrobial infection was found in 38 patients. Gram-positive pathogens were isolated from 26 patients, and Gram-negative microbes were isolated from 41 patients. Of all the isolates collected (n = 70), Staphylococcus aureus was the most prevalent organism (20) and Morganella morganii was the least common (only one isolate). Among Gram-negative bacteria Escherichia coli15 (36.58%) was dominant, followed by K. pneumoniae 11 (26.83%), P. mirabilis 7 (17.07%), P.aeruginosa 4 (9.76%) and A.baumannii 3 (7.32%), and finally Morganella morganii 1 (2.44%). While Gram-positive bacteria including Staphylococcus aureus, S. aureus, were the most isolated bacteria in this study with a percentage of 20 (76.93%), followed by Streptococcus 4 (15.38%) and finally Enterococcus with a percentage of 2 (7.69%). We conclude from the current study that E. coli is the most common cause of foot ulcers in people with diabetes, after S. aurus.
