Objective. This study was aimed at identifying factors that affect the healing of foot ulcers among patients with type 2 diabetes, focusing on the evaluation of oxidative stress-one marker of the inflammatory response.
Methods: A cross sectional study comprised of 96 subjects who were divided into 6 groups (16 subjects in each group). The groups were classified as non-diabetic control (group I), diabetic subjects without foot ulcer (group II), diabetic subjects with foot ulcers were sub-divided as neuropathic ulcer-noninfected (group III), neuropathic ulcer-infected (group IV), neuroischemic ulcer-noninfected (group V), and neuroischemic ulcer-infected (group VI). Oxidative stress markers such as lipid peroxidation, thiobarbituric acid reactive substance (TBARS), superoxide dismutase (SOD), catalase, G-peroxidase, GS-peroxidase, and plasma total antioxidant status were assayed in the blood samples.
Results: Lipid peroxidation increased progressively from group I to group VI subjects (P < 0.001). The TBARS in erythrocyte membrane was higher than in plasma. A progressive decrease of the total antioxidant status in plasma from group III to group VI (P < 0.01) was noted. There was a triggering increase in the antioxidative enzymes SOD and catalase in group V and group VI.
Conclusion: There is a high level of lipid peroxidation with insufficient antioxidant enzymes and decreased total antioxidant status in plasma that leads to chronic ulceration and an extended inflammatory reaction. Thus, oxidative stress may be regarded as an important factor in nonhealing diabetic foot ulcers among patients with type 2 diabetes. .