title: Diabetic nephropathy but not HbA1c is predictive for frequent complications of Charcot feet - long-term follow-up of 164 consecutive patients with 195 acute Charcot feet.
abstract: OBJECTIVE
  To investigate the clinical characteristics, treatment and long-term outcome of patients with acute Charcot feet (CF).
  
  
  METHODS
  Single-center retrospective analysis. Treatment of CF: stage-dependent immobilization/weight-off therapy, orthopaedic/adjusted shoes, foot surgery. 164 consecutive participants (type 1 vs. type 2 diabetes): 12 vs. 150, non-diabetic peripheral neuropathy: n=2, presented with 195 (17 vs. 176) CF. Mean follow-up: 4.7 ± 2.5 (range 2.2-9.8) vs. 5.4 ± 2.9 (range 0.8-18.8) years, vital at follow-up: 100 vs. 88%.
  
  
  RESULTS
  Baseline characteristics: age: 43.7 ± 10.9 vs. 57.9 ± 8.9 years (p<0.001), male gender: 66.7 vs. 77.3%, diabetes duration: 19.2 ± 9.1 vs. 13 ± 8.6 years (p=0.018), GHb: 8.1 ± 2.4 vs. 7.6 ± 1.6%, BMI: 24 ± 5.3 vs. 33.7 ± 6.5 kg/m2 (p<0.001), Levine 1: 18.2 vs. 7.4%, Levine 2: 45.5 vs. 65.9%, Sanders 2: 58.3 vs. 68.5%, Sanders 3: 33.3 vs. 45%.
  
  
  METHODS
  immobilization for 6 ± 4.2 vs. 5.4 ± 4.5 months, orthopaedic/adjusted shoes: 27.3 vs. 20.5%, foot surgery: 11.8 vs. 18.2%. Major complications: 50 vs. 56% (rocker bottom deformities: 23.5 vs. 46.3%, foot ulcerations: 17.6 vs. 24.6%, CF amputations: 0 vs. 6%), not CF amputations: 16.7 vs. 15.3%, second episodes of CF: 41.6 vs. 18.3% after 5-132 months. Diabetic nephropathy was associated with an increase, intensive antihypertensive therapy with a decrease of complications.
  
  
  CONCLUSIONS
  Patients with CF are middle-aged, overweight males with type 2 diabetes above 10 years. Patients with type 1 diabetes are younger, have normal BMI and longer diabetes duration. Major complications and second episodes of CF are frequent. Diabetic nephropathy could be a risk factor for CF related complications. The awareness for CF must be improved.The study was conducted due to the Declaration of Helsinki.
authors.affiliation: Clinic for Nephrology, Saalfeld, Germany. alexandersaemann@yahoo.com
authors.forename: A
authors.initials: A
authors.lastname: Sämann
authors.forename: S
authors.initials: S
authors.lastname: Pofahl
authors.forename: T
authors.initials: T
authors.lastname: Lehmann
authors.forename: B
authors.initials: B
authors.lastname: Voigt
authors.forename: S
authors.initials: S
authors.lastname: Victor
authors.forename: F
authors.initials: F
authors.lastname: Möller
authors.forename: U A
authors.initials: UA
authors.lastname: Müller
authors.forename: G
authors.initials: G
authors.lastname: Wolf
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001177:Arthropathy, Neurogenic / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D048909:Diabetes Complications / Q000175:diagnosis* / Q000453:epidemiology; D017719:Diabetic Foot / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human