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Lipodystrophy, a Common Risk in Diabetic Foot Ulcers

Sep 18, 2021
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Joan Prifti, PharmD. Candidate, LECOM College of Pharmacy

Patients with lipodystrophy have a high risk of diabetic foot ulcers, especially in the younger population.

Lipodystrophy is a disorder characterized by an abnormal fat distribution in the body. It can refer to an irregular loss or accumulation of fat tissue, and can even cause macrovascular and microvascular complications. Diabetic foot ulcers are a chronic complication of diabetes that can cause loss of lower limbs from amputations. DFU is also a risk factor in diabetes-related mortality. Previous studies have not found a correlation between lipodystrophy and DFU or even a treatment to reduce these complications. Lipodystrophy is a complication caused mainly by familial partial lipodystrophy. This study used an observational retrospective cohort study to understand the correlation between these two disorders, lipodystrophy and diabetic foot ulcers, and which age was the most critical.

 

Approximately 206 patients with lipodystrophy were included in the study. Out of these patients, only nine had diabetic foot ulcers. The other patients had familial partial lipodystrophy, and four of them had severe DFU episodes. The age of the patients ranged from 24 to 60 years old. The researchers’ goal was to understand if patients with lipodystrophy and diabetic foot ulcers had the same high risk as familial partial lipodystrophy patients. At the same time, they focused on the age group that would experience the most severe clinical outcomes. Some of the wound localizations were dorsum, middle or big toe, forefoot, and metatarsal head. The most common type of ulcer that was involved in all episodes was a neuropathic ulcer.

The ulcer size and localizations were very similar to patients with diabetes. But patients with lipodystrophy that presented with a DFU episode were of a younger population (median age 31 years [interquartile range 26–35] vs. 63 [55–70]; P, 0.001). In this population, osteomyelitis was mostly detected, (12 episodes [67%] vs. 158 [40%]; P = 0.027). One patient that had congenital generalized lipodystrophy died from a disseminated foot infection. It was evaluated that diabetic foot ulcers develop at a younger age and have serious outcomes in the long run, such as amputation. The metatarsal head localization had the worse clinical outcome, amputation. A neuropathic ulcer was a critical predictor of diabetic foot ulcers. Even though the most common infection was osteomyelitis, it was not clear if it could have been caused by leptin deficiency in patients with lipodystrophy.

Patients with lipodystrophy represent a high risk of diabetic foot ulcers, especially in the younger population. Eventually, it can lead to severe clinical outcomes, and one of the outcomes is amputation. Another study evaluated the critical moment patients with DFU were experiencing during this pandemic. Since most doctors’ offices were closed, they had to find other alternatives and strategies to take care of them. Therefore, it is crucial to use early preventive strategies in this rare patient population. Some simple tips to prevent diabetic foot ulcers on time would be to check your feet daily for scrapes, swelling, or bruises.  Some other suggestions would be not to walk barefoot or make sure to wear shoes that fit. In addition, lipodystrophy can be prevented by exercising regularly and eating healthy food to reduce fat buildup tissues and rebuild muscles. This study is eye-opening for younger patients with diabetes who are always at high risk of developing these disorders. A limitation in the study was the small sample size, and that the data was collected from five different centers that could have a difference in clinical care.

Practice Pearls:

  • Patients with lipodystrophy represent a high-risk group among patients with diabetic foot ulcers.
  • Lipodystrophy and DFU tend to be developed in a younger population and are associated with severe clinical outcomes.
  • Preventive strategies should be used to prevent diabetic foot ulcers in patients with lipodystrophy.

 

Onur Saydam, Basak Ozgen Saydam, et al. “Diabetic Foot Ulcers: A Neglected Complication of Lipodystrophy.” American Diabetes Association. August 14, 2020. Web. September 3., 2020. https://doi.org/10.2337/dc20-1655

Laura Shin, Frank L. Bowling, et al. “Saving the Diabetic Foot During the COVID-19 Pandemic: A Tale of Two Cities.” American Diabetes Association. June 12, 2020. Web. September 3., 2020. https://doi.org/10.2337/dc20-1176

 

Joan Prifti, PharmD. Candidate, LECOM College of Pharmacy