Association between alcohol consumption and metabolic syndrome in 19,215 middle-aged and elderly Chinese

Aims

To assess the association of alcohol consumption with metabolic syndrome (Mets) in a Chinese population.

Methods

A community-based cross-sectional study was performed in 19,215 participants aged 40 years or over in Shanghai of China during June 2008-April 2009. Information about the alcohol consumption including quantity and type of alcoholic beverage was obtained using a standard questionnaire. Physical examination was performed and fasting blood samples were obtained for the measurements of biochemical indicators.

Results

In male wine-only consumers, after adjusted for age, sex, BMI, education levels, exercise and smoking habit, severe alcohol consumption (≥50.0 g/d), compared with non-alcohol consumption, conferred 53% increased risk of having MetS. In women, alcohol consumption did not have relation to the prevalence of Mets. In the beer-only, liquor-only and mixed type consumers, no significant associations between MetS or its components and the quantity of alcohol consumption were detected.

Conclusions

Our findings suggest that excessive wine consumption (alcohol ≥50.0 g/d) is associated with higher prevalence of MetS in Chinese men.     

Hypertriglyceridaemia either in isolation or in combination with abdominal obesity is strongly associated with atherogenic dyslipidaemia in Asian Indians

Aim

To assess the prevalence of isolated hypertriglyceridaemia (iHTG) and hypertriglyceridaemic waist phenotype (HTWP) in urban adult Asian Indian population and to study their associations with atherogenic dyslipidaemia.

Methods

Data of an epidemiological survey (n = 2117, M:F 1007:1110) was used. Prevalences of iHTG (fasting triglycerides (TG) ≥ 1.7 mmol/l) and HTWP (waist circumference male ≥ 90 cm and female ≥ 80 cm and TG ≥ 1.7 mmol/l), were assessed. Their prevalences in relation to glucose intolerance were also studied. Associations of iHTG and HTWP with the occurrence of atherogenic dyslipidaemia indicated by elevated LDL-C/HDL-C ratio of ≥ 2.5 were assessed using multiple logistic regression analyses.

Results

iHTG, and HTWP were present in 13.4% and 17.8% respectively. Prevalence of HTWP was significantly higher among women. Prevalence of HTWP progressively increased with glucose intolerance. Nearly 60% of the subjects with iHTG or HTWP had atherogenic dyslipidaemia and prevalence was similar in both groups.

Conclusions

Hypertriglyceridaemia, present either as iHTG or HTWP was strongly associated with atherogenic dyslipidaemia. Dyslipidaemia occurred more frequently in glucose intolerance since the prevalence of both forms of hypertriglyceridaemia increased with glucose intolerance.     

Higher Cardiovascular Disease Prevalence and Mortality among Younger Blacks Compared to Whites

Background

Blacks have higher rates of cardiovascular disease than whites. The age at which these differential rates emerge has not been fully examined.

Objective

We examined cardiovascular disease prevalence and mortality among black and white adults across the adult age spectrum and explored potential mediators of these differential disease prevalence rates.

Methods

We conducted a cross-sectional analysis of National Health and Nutrition Examination Survey data from 1999-2006. We estimated age-adjusted and age-specific prevalence ratios (PR) for cardiovascular disease (heart failure, stroke, or myocardial infarction) for blacks versus whites in adults aged 35 years and older and examined potential explanatory factors. From the National Compressed Mortality File 5-year aggregate file of 1999-2003, we determined age-specific cardiovascular disease mortality rates.

Results

In young adulthood, cardiovascular disease prevalence was higher in blacks than whites (35-44 years PR 1.9; 95% confidence interval [CI], 1.1-3.4). The black-white PR decreased with each decade of advancing age (P for trend = .04), leading to a narrowing of the racial gap at older ages (65-74 years PR 1.2; 95% CI, 0.8-1.6; ≥75 years PR 1.0; 95% CI, 0.7-1.4). Clinical and socioeconomic factors mediated some, but not all, of the excess cardiovascular disease prevalence among young to middle-aged blacks. Over a quarter (28%) of all cardiovascular disease deaths among blacks occurred in those aged <65 years, compared with 13% among whites.

Conclusions

Reducing black/white disparities in cardiovascular disease will require a focus on young and middle-aged blacks.     

Prevalence of obesity and associated risk factors in Northeastern China

Aim

To investigate the prevalence of obesity and associated risk factors in the Northeastern Chinese city of Dehui.

Methods

A cross-sectional study involving random sampling methods generated 3598 completed questionnaires by permanent residents of Dehui. Binary multivariate logistic regression analysis was used to identify factors that were significantly associated with obesity.

Results

Based on the 2000 WHO diagnostic criterion regarding populations in the Asia-Pacific region, the prevalence of obesity was 37.71% (34.77% of females; 41.11% of males). Elevated body mass index (BMI) was significantly associated with cardiovascular disease (CVD)-associated conditions (P < 0.05), and increased prevalence of abnormally high transaminase levels (P < 0.05). Binary logistic regression analysis demonstrated the following variables were associated with obesity: increased age (odds ratio [OR]: 1.01, 95% confidence interval [CI]: 1.0-1.02), high total cholesterol (TC) (OR: 1.26, 95% CI: 1.03-1.54), high triglycerides (TG) (OR: 1.38, 95% CI: 1.16-1.64), hypertension (OR: 1.62, 95% CI: 1.39-1.90), fatty liver (OR: 2.91, 95% CI: 2.41-3.49), living in an urban setting (OR: 2.84, 95% CI: 2.39-3.38), and advanced education (OR: 1.22, 95% CI: 1.06-1.40).

Conclusions

Obesity is prevalent among the adult population in Northeastern China and is significantly associated with CVD risk factors such as hypertension, dyslipidemia, as well as transaminase abnormalities.     

Impact of introducing HbA1c into the diagnostic criteria on prevalence and cardiovascular risk profiles of individuals with newly diagnosed diabetes in Japan: the Toranomon Hospital Health Management Center Study 2 (TOPICS 2)

Objective

To evaluate the impact of HbA1c for diagnosis of diabetes and investigate whether cardiovascular risks profiles differ among individuals with diabetes diagnosed by HbA1c or fasting plasma glucose (FPG).

Methods

This cross-sectional study involved 26,884 participants (30.6% women; aged 20-91 years) without known diabetes. Subjects were categorized into 4 groups according to the presence or absence of FPG ≥7.0 mmol/L and/or HbA1c ≥6.5%, which were American Diabetes Association criteria. Oral glucose tolerance test data were not available.

Results

Prevalence of undiagnosed diabetes was 3.6%. Of those individuals, 47.5% fulfilled both two criteria and 26.0% fulfilled only HbA1c criterion. Individuals with diabetes according to FPG ≥7.0 mmol/L alone were characterized as having poorly controlled hypertension while those with HbA1c ≥6.5% alone were characterized as older, female, and having lower blood pressure and γ-glutamyltransferase values. Persons with newly diagnosed diabetes by HbA1c had low HDL cholesterol and high LDL or non-HDL cholesterol levels.

Conclusions

Introducing HbA1c into the diagnosis allowed detection of many previously undiagnosed cases of diabetes in Japanese individuals. Those diagnosed by FPG were characterized by hypertension and those diagnosed by HbA1c had unfavorable lipid profiles, reflecting an atherosclerotic trait.     

Feasibility of group lifestyle intervention for diabetes prevention in Arab Americans

Aims

To assess the feasibility and acceptability of a community-based, culturally-specific, Diabetes Prevention Program (DPP)-adapted, group lifestyle intervention in Arab-Americans.

Methods

Overweight (BMI ≥ 27 kg/m²) Arab-Americans aged ≥30 years and without a history of diabetes were recruited to participate in a 24-week group lifestyle intervention. The DPP core-curriculum was culturally rewritten, translated into Arabic, and delivered in weekly sessions over a 12-week period. Follow-up was performed at week-24. The primary goals were to achieve ≥7% weight loss and ≥150 min/week of physical activity. An intent-to-treat analysis was performed.

Results

Of the 71 participants (mean age ± SD 47 ± 10 years, 38% males), 44% achieved ≥7% weight loss, 59% achieved ≥5% reduction in weight, and 78% reached the physical activity goal of ≥150-min/week. The mean ± SD weight loss was 5.2 ± 4.4 kg at week-24 (p < 0.0001), Marked reduction in body measurements, daily energy and fat intake were noted. Retention was high with 86% completing the intervention.

Conclusions

This trial demonstrates that a culturally-specific, DPP-adapted, group lifestyle intervention implemented in a community setting is feasible and effective in Arab-Americans.     

Contribution of first trimester fasting plasma insulin levels to the incidence of glucose intolerance in later pregnancy: Tanaka women's clinic study

Aims

To clarify risk factors predictive of glucose intolerance in later pregnancy.

Methods

We prospectively studied 509 pregnant women who visited the obstetrics clinic in Tokyo prior to week 13 of gestation, between September 2008 and January 2010. Biochemical parameters were measured in fasting plasma samples collected at week 8.0 ± 2.0 of gestation. A 50 g glucose challenge test (GCT) was performed between weeks 26 and 29: plasma glucose levels ≥7.8 mmol/l 1 h after ingestion indicated a positive GCT. Logistic regression was performed, adjusting for relevant covariates.

Results

We identified 114 patients with positive GCTs, including 8 with gestational diabetes mellitus (GDM). After correcting for baseline body mass index, only the homeostasis model assessment of insulin resistance value remained a significant predictor of GCT positivity (OR 2.07; 1.21-3.55). We identified threshold values of fasting plasma glucose (FPG) ≥3.66 mmol/l and fasting plasma insulin (FPI) ≥36.69 pmol/l as indicative of a higher risk of positive GCT (OR 2.38; 1.49-3.80).

Conclusions

First trimester FPI levels improve the predictive ability of FPG level on subsequent GCT positivity.     

Overweight, obesity, and elevated serum cystatin C levels in adults in the United States

Background

Although high body mass index (BMI) is a risk factor for hypertension, diabetes, and cardiovascular disease, limited data exist on the association of overweight and obesity with early stages of kidney disease.

Methods

Cross-sectional data for 5083 participants of the nationally representative Third National Health and Nutrition Examination Survey with an estimated glomerular filtration rate ≥ 60 mL/min/1.73 m² without micro- or macroalbuminuria were analyzed to determine the association between BMI and elevated serum cystatin C. Normal weight, overweight, class I obesity, and class II to III obesity were defined as a BMI of 18.5 to 24.9 kg/m², 25.0 to 29.9 kg/m², 30.0 to 34.9 kg/m², and ≥ 35.0 kg/m², respectively. Elevated serum cystatin C was defined as ≥ 1.09 mg/L (≥99th percentile for participants 20-39 years of age without diabetes, hypertension, micro- or macroalbuminuria, or stage 3-5 chronic kidney disease).

Results

The age-standardized prevalence of elevated serum cystatin C was 9.6%, 12.9%, 17.4%, and 21.5% among adults of normal weight, overweight, class I obesity, and class II to III obesity, respectively (P trend < .001). After multivariate adjustment for demographics, behaviors, systolic blood pressure, and serum biomarkers, and compared with participants of normal weight, the odds ratio (95% confidence interval) of elevated serum cystatin C was 1.46 (1.02-2.10) for overweight, 2.36 (1.56-3.57) for class I obesity, and 2.82 (1.56-5.11) for class II to III obesity.

Conclusion

A graded association exists between higher BMI and elevated serum cystatin C. Further research is warranted to assess whether reducing BMI favorably affects elevated serum cystatin C and the development of chronic kidney disease.     

CARMELA: assessment of cardiovascular risk in seven Latin American cities

Objective

This cross-sectional, population-based observational study using stratified multistage sampling assessed the prevalence of cardiovascular risk factors and carotid plaques and measured carotid intima-media thickness in individuals living in major cities in 7 Latin American countries.

Patients and Methods

The study comprised individuals (n = 11,550) aged 25 to 64 years, living in Barquisimeto, Bogota, Buenos Aires, Lima, Mexico City, Quito, and Santiago. Data on anthropometric parameters, blood pressure, fasting glucose, total and high-density lipoprotein cholesterol, triglycerides, carotid intima-media thickness, carotid plaque, and smoking status were collected through household interviews and clinical, biochemical, and sonographic measurements.

Results

The overall prevalence rates (ranges across cities) were as follows: hypertension (≥140/90 mm Hg or pharmacologic treatment), 18% (9%-29%); hypercholesterolemia (total cholesterol ≥240 mg/dL), 14% (6%-20%); diabetes (glycemia ≥126 mg/dL or self-reported diabetes), 7% (4%-9%); metabolic syndrome, 20% (14%-27%); obesity (body mass index ≥30 kg/m²), 23% (18%-27%); smoking, 30% (22%-45%); and plaque, 8% (5%-14%). The mean intima-media thickness was 0.65 mm (0.60-0.74 mm).

Conclusion

The prevalence of hypertension mirrored the world average in 3 cities but was lower in the rest. Hypercholesterolemia was highly prevalent even in countries of different socioeconomic levels. The prevalence of diabetes was similar to that in the developed countries. Tobacco use in women living in Santiago and Buenos Aires was among the world’s highest. Intima-media thickness and carotid plaque prevalences varied widely.     

Facteurs de risque cardiovasculaire chez les travailleurs postés d’une centrale de production d’électricité au centre tunisien

The purpose of the study

The aim of the present study was to investigate relationship between shift work and the cardiovascular risk factors.

Methods

A cross-sectional study was included 330 subjects worked in a company of electricity production in the Centre of Tunisia. The collection of data was based on a questionnaire, a clinical exam and biomarkers.

Results

A total of 290 workers was participated in our study (128 shift workers and 162 daytime workers). A raised prevalence but not statistically significant of some factors of cardiovascular risks was found in the shift workers: obesity (25.8 % versus 17.9 %), smoking (44.5 % versus 39.5 %), impaired fasting glucose (11.7 % versus 9.9 %), hypertriglyceridemia (28.1 % versus 25.9 %) and hypercholesterolemia (14.8 % versus 12.4 %). Whereas the prevalence of the alcohol consumption (25.8 % versus 16.0 %) was significantly higher in the shift workers (p = 0.04).

Conclusion

The high prevalence of the cardiovascular risk factors, observed in our shift workers, justify the adoption of measures to protect this category of workers.     

Diabetes and impaired glucose tolerance among Turkish immigrants in Sweden

Aim

To investigate whether the prevalence of diabetes and impaired glucose tolerance (IGT) was higher among Turkish immigrants in Sweden, than in their area of origin in Turkey.

Methods

238 Turkish immigrants aged 20 years and older living in Flemingsberg, Sweden, were compared with 1549 participants of the same age living in the Konya area of Turkey. Data collection included anthropometric measurements, blood pressure (BP) measurements, and an oral glucose tolerance test (OGTT).

Results

Prevalence of laboratory-verified diabetes was 11.8% among participants in Sweden compared to 7.1% among participants in Turkey (p 0.018). Turkish women in Sweden had a higher prevalence of diabetes than Turkish women in Turkey, 12.8% vs. 7.6% (p = 0.037). Similarly, IGT was 17.8% among Turkish men in Sweden compared to 4.9% among men in Turkey (p < 0.001) and 2-h blood glucose was higher among the immigrants (p < 0.001). Systolic BP was also higher among the immigrants, especially in men (p < 0.001) who also had a higher BMI (p = 0.003).

Conclusions

The higher prevalence of diabetes and IGT among Turkish immigrants in Flemingsberg, Sweden, suggests that migration is associated with diabetes and that there are important implications for public health in Sweden.     

Clinical impact of screening for sleep related breathing disorders in atrial fibrillation

Objective

The aim of this study was to quantify daytime symptoms in atrial fibrillation (AF) patients with and without sleep related breathing disorders (SRBD).

Background

SRBD are common in patients with AF but little is known about daytime symptoms among those with SRBD.

Methods

Patients with AF admitted to clinics of two tertiary referral hospitals for a variety of different cardiovascular diseases were screened with a trans-nasal airflow measurement device allowing measurement of the apnea-hypopnea-index. Data on cardiac risk factors, left ventricular ejection fraction (LVEF) and cardiac medication were collected. Presence of SRBD was defined as an AHI ≥ 15/h. The Epworth sleepiness scale (ESS) was used to quantify daytime symptoms.

Results

Of 102 screened patients 8 were excluded due to device malfunction (n = 1), dislocation of nasal cannula (n = 6), or hyperthyroidism (n = 1). Among the remaining 94 patients, 40 (43%) were diagnosed with SRBD. Patients with and without SRBD had similar age, body mass index, LVEF and cardiac medication. The prevalence of coronary artery disease was higher in patients with SRBD than in those without (50 vs. 17%; p = 0.0007). ESS score was low and similar in both groups (no SRBD: median 4, interquartile range (IQR) 2-4 vs. SRBD: 5, IQR 3-8; p = 0.14). Only 6/40 (5%) of the patients underwent overnight polysomnography and 2 (5%) started CPAP ventilation during follow-up.

Conclusions

Even though SRBD are common in patients with AF, the prevalence of daytime symptoms is rare. Consequently, most patients will not initiate CPAP ventilation after positive SRBD screening.     

Measuring health related quality of life in coronary heart disease: The importance of feeling well

Background

Atrial tachyarrhythmias are associated with patent foramen ovale. The objective was to determine the anti-arrhythmic effect of patent foramen ovale closure on pre-existing atrial tachyarrhythmias.

Methods

Medline, EMBASE, Cochrane Library, and Google Scholar databases were searched between 1967 and 2010. The search was expanded using the ‘related articles’ function and reference lists of key studies. All studies reporting pre- and post-closure incidence (or prevalence) of atrial tachyarrhythmia in the same patient population were included. Random and fixed effect meta-analyses were used to aggregate the data.

Results

Six studies were identified including 2570 patients who underwent percutaneous closure. Atrial fibrillation was in fact the only AT reported in all studies. Meta-analysis using a fixed effects model demonstrated a significant reduction in the prevalence of atrial fibrillation with an OR of 0.43 (95% CI 0.26-0.71). When using the random-effects model, OR was 0.44 (95% CI 0.18-1.04) with a statistically significant trend demonstrated (test for overall effect: Z = 1.87, p = 0.06).

Conclusion

Closure of a patent foramen ovale may be associated with reduction in the prevalence of atrial fibrillation.     

Reducing Psychosocial Stress: A Novel Mechanism of Improving Survival from Exercise Training

Background

Exercise training reduces mortality in patients with coronary artery disease. Behavioral characteristics, including depression, hostility, and overall psychosocial stress, have been shown to be independent risk factors for recurrent myocardial infarction and death in these patients. Exercise training can reduce these high-risk behaviors, but it remains uncertain as to what extent the health benefits of exercise training can be attributed to improving these behaviors.

Methods

We evaluated the impact of exercise training during cardiac rehabilitation on mortality in 53 patients with coronary artery disease with high levels of psychosocial stress and in 469 patients with coronary artery disease with low levels of psychosocial stress and compared them with 27 control patients with high psychosocial stress who did not undergo formal cardiac rehabilitation and exercise training.

Results

Mortality was approximately 4-fold greater in patients with high psychosocial stress than in those with low psychosocial stress (22% vs 5%; P = .003). Exercise training decreased the prevalence of psychosocial stress from 10% to 4% (P < .0001) and similarly improved peak oxygen uptake in patients with high and low psychosocial stress. Mortality in patients who improved exercise capacity by ≥ 10% (high exercise change) was 60% lower than in patients who had < 10% improvement in exercise capacity (low exercise change) (P = .009). Mortality was lower in patients with high psychosocial stress with high exercise change compared with patients with high psychosocial stress with low exercise change (0% vs 19%; P = .009). In contrast, there was no significant improvement in mortality in patients with high versus low exercise change with low psychosocial stress (4% vs 8%; P = .14).

Conclusion

Psychosocial stress is an independent risk factor for mortality in patients with coronary artery disease, and exercise training can effectively reduce its prevalence. Exercise training reduces mortality in patients with coronary artery disease, and this effect seems to be mediated in part because of the salutary effects of exercise on psychosocial stress.     

Attribution of functional limitation to cancer decreases in the year following breast cancer diagnosis in older patients

Objectives

To examine the prevalence of self-reported functional limitations in a breast cancer population, identify whether these reported limitations are attributed to breast cancer versus other coexisting illnesses, and examine how this attribution changes over time from early in treatment to 9 months later.

Design

Longitudinal, observational study.

Setting

Community dwelling adults in Detroit metropolitan area.

Participants

2033 participants (1011 breast cancer patients, 1022 controls) aged 40-84 years.

Measurements

Participants were asked about each of 23 possible coexisting illnesses in addition to breast cancer and whether or not each illness, including breast cancer, caused any activity limitation.

Results

Of the 933 cancer patients who completed both baseline and follow-up evaluations, 45% were aged 65 years and older. At baseline, 56% of patients 65 years and older reported functional limitation compared with 50% of patients younger than 65 years (p = 0.005). Of those patients who reported limitation at baseline, 59% of older patients and 78% of younger patients attributed their limitation to breast cancer (p < 0.001). At follow-up, 53% of older and 37% of younger patients reported functional limitation (p < 0.001), with 27% of older patients compared with 57% of younger patients (p < 0.001) attributing limitation to breast cancer.

Conclusion

Self-reported functional limitations are common 3 months after breast cancer diagnosis, being attributed primarily to breast cancer. By 1 year after diagnosis, much of the limitation due to breast cancer resolves. Older women are less likely to have resolution of their limitations, which are most commonly due to other coexisting illnesses.     

Prevalence and long-term glucose metabolism evolution of post-transplant diabetes mellitus in Chinese renal recipients

Aim

To assess the prevalence and predictors of post-transplant diabetes mellitus (PTDM) in Chinese renal recipients and describe their long-term evolution of glucose metabolism.

Methods

887 non-diabetic Chinese adult renal recipients were studied retrospectively, with a median follow-up of 7 years. PTDM patients were categorized into transient PTDM and permanent PTDM. The cumulative incidence and risk factors of PTDM were estimated by Kaplan-Meier and Cox regression.

Results

The cumulative incidence of PTDM at 3 months, 1, 3, 5, 10, 15 and 20 years post-transplant was 10.4%, 11.4%, 13.4%, 15.2%, 22.7%, 27.9% and 38.3%, respectively. 61.9% of PTDM cases were diagnosed within the first three months and 61.6% of them developed persistent diabetes in the future. Risk factors for all PTDM included older age, body mass index (BMI) ≥ 25 kg/m², triglycerides ≥ 1.5 mmol/L, rejection, the use of tacrolimus and diltiazem. The predictors of permanent PTDM included age >50 years (RR = 2.322, 95% CI 1.255-4.296, P = 0.007), BMI ≥ 25 kg/m² (RR = 1.699, 95% CI 1.014-2.846, P = 0.044) and the use of tacrolimus (RR = 1.835, 95% CI 1.181-2.851, P = 0.007).

Conclusions

Patients were most susceptible to PTDM within the first three months post-transplant and more than half of them developed persistent diabetes in the future. Age >50 years, overweight and tacrolimus application were risk factors for both PTDM and permanent PTDM.     

Which metabolic syndrome criteria best predict the presence of non-alcoholic fatty liver disease?

Aims

To know which MS criteria best predict the presence of NAFLD and the prevalences of metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD) diagnosed ultrasonographically among pre-diabetic and diabetic subjects based on three different MS criteria (IDF, ATP III, WHO).

Methods

Subjects were screened and those with a fasting serum glucose level ≥100 mg/dL were further tested with a 75 g oral glucose tolerance test. And those who were newly diagnosed as having pre-diabetes or diabetes were evaluated for MS and NAFLD. We compared the risk ratios of NAFLD among three MS criteria using multivariate and multiple logistic regression analyses.

Results

A total of 1365 subjects (977 males, mean age 48.4 ± 9.5 years) were analyzed. The WHO criteria produced the highest prevalence of MS in both the pre-diabetic (49.8%) and diabetic (58.9%) groups. The IDF criteria produced the highest odds ratio for NAFLD in both pre-diabetic (3.89 [95% CI 2.75-5.51]) and diabetic (5.53 [95% CI 3.21-9.52]) groups.

Conclusions

The prevalence of MS depends on the set of diagnostic criteria used. IDF criteria best predicts the presence of NAFLD. The presence of NAFLD should be considered as a component of the diagnostic criteria for MS.     

Treatment of diabetic foot ulcers: a comparative study of extracorporeal shockwave therapy and hyperbaric oxygen therapy

Objective

This study compared the effectiveness of extracorporeal shockwave therapy (ESWT) and hyperbaric oxygen therapy (HBOT) in chronic diabetic foot ulcers.

Patients and methods

The ESWT group (39 patients/44 feet) received shockwave therapy twice per week for total six treatments. The HBOT group (38 patients/40 feet) received hyperbaric oxygen therapy daily for total 20 treatments. Evaluations included clinical assessment, blood flow perfusion scan and histopathological examination.

Results

The overall clinical results showed completely healed ulcers in 57% and 25% (P = 0.003); ≥50% improved ulcers in 32% and 15% (P = 0.071); unchanged ulcers in 11% and 60% (P < 0.001) and none worsened for the ESWT and the HBOT group respectively. The blood flow perfusion rates were comparable between the two groups before treatment (P = 0.245), however, significant differences were noted after treatment favoring the ESWT group (P = 0.002). Histopathological examination revealed considerable increases in cell proliferation and decreases in cell apoptosis in the ESWT group as compared to the HBOT group.

Conclusion

ESWT is more effective than HBOT in chronic diabetic foot ulcers. ESWT-treated ulcers showed significant improvement in blood flow perfusion rate and cell activity leading to better healing of the ulcers relative to HBOT in chronic diabetic foot ulcers.