Clinical profile and laboratory finding of diabetic foot ulcers from tertiary hospitals in Bali
I Nyoman Semadi 1  
,   Kelvin Setiawan 2  
,   Hendry Irawan 2  
More details
Hide details
Thorax and Cardiovascular Surgery Division, General Surgery Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
General Surgery Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
Hendry Irawan   

General Surgery Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Jl. Diponegoro, Denpasar, Bali, Indonesia 80113. Tel.: +62 361 227912
Submission date: 2019-11-15
Final revision date: 2020-04-24
Acceptance date: 2020-04-24
Online publication date: 2020-08-06
Diabetic foot ulcer (DFU), as one of the chronic non-healing wounds, causes a significant financial burden on the healthcare system worldwide. Chronic wounds usually exhibit powerful pro-inflammatory stimuli, as seen in laboratory results.

For this reason, we conducted an observational study to obtain the clinical profile, hematological profile, and biochemical profile from our DFU patient laboratory examinations.

Material and methods:
This study was a retrospective descriptive study conducted between March 2016 and December 2018 in Sanglah Hospital, Bali which included a total of 113 patients. The variables included in this study consisted of DFU clinical status, treatment procedures, and laboratory results. We further divided the laboratory results into two groups, haematological and blood chemistry profile. All numerical data were summarized as mean ± standard deviation, and categorical variables were summarized as frequency and percentage.

Results and discussion:
The mean patient’s age was 55.68 ± 10.52 years old. The most of patients were male (54.9%). Leukocytosis was observed in these patients (13.80 ± 6.48 × 109/L) and neutrophil dominated the white blood differential count. There were 35 patients (30.97%) with creatinine levels above 1.3 mg/dL, 73 patients (64.6%) with random blood glucose above 180 mg/dL, and 78 patients (67.3%) with HbA1c levels higher than 53 mmol/mol, even 33 patients (29.2%) with HbA1c more than 86 mmol/mol.

Some laboratory values have a significant meaning in diabetic foot patients, which can become instruments for the physician in diagnosing, select the most effective treatment, and predict outcome or complications in DFU patients.

All the authors have no conflicts of interest.
Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol. 2018;14(2):88–98.
Zimmet PZ, Alberti KG. Epidemiology of Diabetes-Status of a Pandemic and Issues Around Metabolic Surgery. Diabetes Care. 2016;39(6):878–883.
Balducci S, Sacchetti M, Haxhi J, et al. Physical exercise as therapy for type II diabetes. Diabetes Metab Res Rev. 2014;30(Suppl 1):13–23.
Kayssi A, Rogers LC, Neville RF. General Considerations in Diabetic Foot Ulcers. In: Sidawy AN, Perler BA, eds. Rutherford’s Vascular Surgery and Endovascular Therapy. 9th Ed. Philadelphia: Elsevier Inc. 2019;1514–1526.
International Diabetes Federation. IDF Clinical Practice Recommendations on the Diabetic Foot – 2017: A Guide for Healthcare Professionals. Brussels: International Diabetes Federation; 2017. Accessed: 03.08.2020.
Pemayun TGD, Naibaho RM. Diabetes Management Diabetic Foot Ulcer Registry at a Tertiary Care Hospital in Semarang, Indonesia: an Overview of its Clinical Profile and Management Outcome. J Clin Diabetes Pract. 2016;6(4):82–89.
Leong M, Murphy KD, Phillips LG. Wound healing. In: Townsend Jr CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 20th Ed. Philadelphia: Elsevier. 2017;130–162.
Barbul A, Efron DT, Kavalukas SL. Wound healing. In: Brunicardi FC, Andersen DK, Billiar TR, et al., eds. Schwartz Principles of Surgery. 10th Ed. New York: McGraw Hill Education. 2015;241–271.
Kratz A, Ferraro M, Sluss PM, Lewandrowski KB. Normal reference laboratory values. N Engl J Med. 2004;351(15):1548–1563.
Powers AC. Diabetes mellitus. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 18th Ed. New York: McGraw Hill Education. 2011;2968–2970.
Viswanathan V, Thomas N, Tandon N, et al. Profile of diabetic foot complications and its associated complications - A multicentric study from India. J Assoc Physicians India. 2005;53:933–936.
Tarigan TJE, Yunir E, Subekti I, Pramono LA, Martina D. Profile and analysis of diabetes chronic complications in Outpatient Diabetes Clinic of Cipto Mangunkusumo Hospital, Jakarta. Med J Indones. 2015;24(3):156–162.
Pemayun TGD, Naibaho RM, Novitasari D, Amin N, Minuljo TT. Risk factors for lower extremity amputation in patients with diabetic foot ulcers: A hospital-based case-control study. Diabet Foot Ankle. 2015;6.
Bowker JH. Minor and major lower-limb amputations and disarticulations in patients with diabetes mellitus. In: Bowker JH, Pfeifer MA. Levin and O’Neal’s the Diabetic Foot. 7th Ed. Philadelphia: Elsevier Inc. 2008;403–428.
Demirdal T, Sen P. The significance of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and lymphocyte-monocyte ratio in predicting peripheral arterial disease, peripheral neuropathy, osteomyelitis and amputation in diabetic foot infection. Diabetes Res Clin Pract. 2018;144:118–125.
Metineren H, Dülgeroğlu TC. Comparison of the Neutrophil/Lymphocyte Ratio and C-Reactive Protein Levels in Patients With Amputation for Diabetic Foot Ulcers. Int J Low Extrem Wounds. 2017;16(1):23–28.
Balta S, Celik T, Mikhailidis DP, et al. The relation between atherosclerosis and the Neutrophil-Lymphocyte ratio. Clin Appl Thromb Hemost. 2016;22(5):405–411.
Goldman MP, Clark CJ, Craven TE, et al. Effect of intensive glycemic control on risk of lower extremity amputation. J Am Coll Surg. 2018;227(6):596–604.
Bhonsle HS, Korwar AM, Kote SS, et al. Low plasma albumin levels are associated with increased plasma protein glycation and HbA1c in dDiabetes. J Proteome Res. 2012;11(2):1391–1396.
Shatnawi NJ, Al-Zoubi NA, Hawamdeh HM, Khader YS, Garaibeh K, Heis HA. Predictors of major lower limb amputation in type 2 diabetic patients referred for hospital care with diabetic foot syndrome. Diabetes Metab Syndr Obes. 2018;11:313–319.
Kahraman C, Yümün G, Kahraman NK, Namdar ND, Cosgun S. Neutrophil-to-lymphocyte ratio in diabetes mellitus patients with and without diabetic foot ulcer. Eur J Med Sci. 2014;1(1):8–13.
Vatankhah N, Jahangiri Y, Landry GJ, et al. Predictive value of neutrophil-to-lymphocyte ratio in diabetic wound healing. J Vasc Surg. 2016;65(2):478–483.
Semadi IN, Irawan H. Blood glucose and lipid profile in patients with diabetic foot ulcer that underwent hyperbaric oxygen therapy. Bali Med J. 2017;6(2):405–408.