Correlation of CRP Level with Glycemic Control in Diabetic Foot Patients and Its Sequelae

INTRODUCTION: The term diabetes was coined by Aretaeus of Cappadocia.it was derived from the greek word “diabainein”. Diabetes means one that straddles. Diabetes was recorded first in English as Diabete around 1425. In 1675, the word mellitus was added by Thomas willis. Matthew Dobson in 1776, confirmed the excess sugar in urine and blood. Sushrutha named diabetes as Madumeha (sweet urine disease) in 6th century. Avicenna Persian (980–1037) described diabetic gangrene. The role of pancreas in diabetes was first by Joseph von Mering and Minkowski. 1910 sir Edward albert Sharpey Shafer suggested that diabetic people were deficient in insulin. Banting and Best purified insulin from bovine pancreas for which he was awarded noble price. Banting is honoured by worlds diabetes day which is held on his birthday, November, 14. Amputations surgical principals was first given by Ambrose Pare. AIMS AND OBJECTIVES: The purpose of the present study is To analyze the level of CRP and adequacy of glycemic control To correlate the level of CRP with sequelae of diabetic foot. MATERIALS AND METHODS: Setting: Department of General Surgery, Government Stanley Hospital, Chennai. Study Design: Prospective Observational. Study Period: 1 years. Materials: Approx. 100 patients. Inclusion Criteria: All type 2 DM on treatment and diabetic foot. Exclusion Criteria: Patients with clinical or biochemical evidence sepsis other than diabetes foot. Patients with active auto immune disease (RA, SLE, systemic sclerosis). Admission sugar values, CRP values are obtained. Blood and estimation done by standard method. Grading of diabetic foot is as per wagner classification. As the protocol all patients treated with medical surgical care available in institution. Throughout admission serial measurements blood documented. Weekly obtained till discharge. Using statistical analysis correlated grade treatment outcome. The study after sign informed consent form. OBSERVATION AND RESULTS: From January 2012 to November 2012, a total of 100 patients who was admitted with diabetic foot in the Department Of General Surgery ,Government Stanley Hospital was studied. After admission routine blood investigations radiological evaluation. Wound swab culture and sensivity were done. Blood sugar values both fasting and post prandial and c reactive protein levels were checked in all patients. Both oral and intravenous antibiotics were prescribed according to the pus culture and sensitivity report. Initial through surgical debridement was done. Daily dressings were done. The fasting blood sugar value ranges from 127 to 225 . minimum value is presentation 127 and the maximum value 225.patients are categorized into five groups to find the distribution. CONCLUSION: From our study it is concluded that glycemic control and CRP has definitive correlation with outcome which is proved by patients with persistently elevated blood sugar levels and CRP went in for amputation in our study. It is also concluded that 33.33% ( 9 patients out of 27) patients with elevated CRP above the critical value of 40 have went in for amputation. Rest of the patients with CRP < 40 went in for wound healing with appropriate surgical management.