Why SINBAD? Describing diabetic foot ulcers in a Barbados population

OBJECTIVE: Here, we report on the characterization of diabetic foot ulcers in a Barbados population using the SINBAD ulcer classification system. SUBJECTS AND METHODS: Sixty-five case participants were seen and 73 ulcers presented. All ulcers were categorized upon examination using the SINBAD classification scheme: Site, Ischaemia, Neuropathy, Bacterial infection, Area, Depth. The individual category scores were summed to create a SINBAD score with a range of 0–6.Results were compiled and analysis performed using Stata SE 12.1 (Stata Corporation). RESULTS: Mean age of the participants was 56.75 (± 9.03SD) years and more were men (53.4%). The mean diabetes duration was 15.25 (± 9.84 SD) years. Three SINBAD scores (1, 2 and 3) shared the majority of the ulcers at 26.0% each. The next highest was SINBAD score 0 at 15.1% of the ulcers, followed by the SINBAD score 4at 6.9%. None of the ulcers seen in the participants (0%)registered a SINBAD score of 5 or 6. The majority of the ulcers were neuropathic (61.64% vs 38.36%), larger than 1cm2 (63.01% vs 36.99%), free of bacterial infection(95.89% vs 4.11%) and confined to the skin and subcutaneous tissue (100% vs 0%). CONCLUSION: The SINBAD ulcer classification score indicates the risk of a foot wound failing to heal, with scores of three and above having a significantly increased time to heal and being classified as complicated. In the current study, 67% of the ulcers seen were scored below the threshold of a SINBAD score of 3.

Albumin/creatinine ratio as an indicator of diabetic foot in a Barbados population

OBJECTIVE: High levels of circulating glucose affect the vasculature in diabetes leading to complications such as retinopathy, nephropathy and diabetic foot. In diabetic nephropathy, the elevated glucose levels also serve to alter the physiology of the glomerulus resulting in elevated albumin excretion. In this case-control study, we examined the Albumin/Creatinine ratio in persons with self-reported type II diabetes, with and without non-healing foot wounds (failure to heal <30 days). DESIGN AND METHODS: Fasting EDTA blood (2ml) samples and urine samples (15ml) were obtained from 90 persons self reported as living with diabetes. Cases were described as persons with non healing foot wounds and controls as persons with no current foot wounds or history of non healing foot wounds. HbA1c levels and Albumin/Creatinine ratios were assessed using a Bayer DCA2000+ Analyser. Fasting glucose levels were determined using a Roche Reflotron+ Analyser. Results were compiled and analysis performed using STATA SE 12.1 (Stata Corporation). RESULTS: Mean HbA1c in cases was 9.1% (ñ2.1 SD) and in controls was 8.3% (ñ1.9 SD) (p=0.05). Mean fasting glucose in cases was 142.19mg/dL (ñ50.76 SD) and in controls 134.57mg/dL (ñ60.10 SD) (p=0.52). Mean Albumin/Creatinine ratio in cases was 210.23 mg/g (ñ275.44 SD) and in controls 42.62 mg/g (ñ103.49 SD) (p<0.001). CONCLUSIONS: In this diabetic case control study, Albumin/Creatinine ratio was markedly higher in persons with diabetes and non-healing foot wounds. This may be a marker of interest as an early indicator of the diabetic foot.