Study of the Association between Plasminogen Activator Inhibitor-1, other Inflammatory Markers, Metabolic Control Parameters, and Diabetic Foot Disease

Abstract

Background: The incidence of type 2 diabetes mellitus (T2DM) has been increasing in recent years. As such, early identification and management of its complications—especially diabetic foot disease (DFD)—is of great importance. Multiple factors are involved in the pathogenesis of DFD; in this study, we aimed to study the association between plasminogen activator inhibitor-1 (PAI-1), high-sensitivity C-reactive protein (hs-CRP), 1st hour erythrocyte sedimentation rate (ESR), and DFD.

Methods: The present work was conducted on 200 T2DM patients with DFD (group I), 200 T2DM patients without DFD (group II), and 100 healthy subjects (group III, as a control group). Serum PAI-1 levels (using ELISA) and other inflammatory markers (hs-CRP and 1^st hour ESR) were measured in the three groups.

Results: T2DM patients with DFD had significantly higher mean serum levels of inflammatory markers (including PAI-1, hs-CRP, and 1st hour ESR) compared to T2DM patients without DFD and the control group (p < 0.001). There was a significant positive correlation between inflammatory markers (including PAI-1, hs-CRP, and 1^st hour ESR), metabolic control parameters (including fasting plasma glucose, 2-hour postprandial plasma glucose, and glycated hemoglobin), and severity of DFD in group I and group II (p < 0.001).

Conclusion: DFD is associated with elevated indicators of systemic and vascular inflammation. PAI-1, hs-CRP, and 1^st hour ESR can be considered as early predictors for vascular tissue damage and can be used for early detection of complications in diabetic patients. Among these indicators, hs-CRP has greater diagnostic value in the detection of DFD.