Some clinical factors contributing to the development of the diabetic foot

Clinical neurological studies, blood pressure measurements and some haemato logical investigations were performed on a random sample of forty-four pati ents, at the Diabetes Out-Patient Clinic of the University Hospital of the West Indies (UHWI), to examine some of the factors that predispose to the d evelopment of the diabetic foot. Our results revealed that 86% of the patie nts had elevated glycosylated haemoglobin (HbA(1), > 9.0%), 82% had clinica l signs of peripheral sensory neuropathy, 29% had signs of autonomic neurop athy in addition to peripheral sensory neuropathy Sixty-one per cent (61%) of the patients had ankle/arm systolic blood pressure ratio less than 1.0 a nd were diagnosed as having peripheral vascular disease (PVD). The group wi th neuropathy was found to have a significantly lower diastolic blood press ure (p < 0.0005) than the group without neuropathy. We believe that hypergl ycaemia-induced vasodilation (indicated by a lower diastolic blood pressure ) in a significant number of diabetics resulted in compensatory shunting of blood from the deeper tissues, including nerves, to the periphery. The res ulting endoneural hypoxia could be responsible for the unusually high incid ence of peripheral sensory neuropathy detected in this sample of diabetic p atients. Metabolic factors may also play a role.