A study of apolipoprotein A1(ApoA1) and interleukin-10(IL-10) in diabetes with foot ulcers

The high morbidity, mortality and associated economic burden have entailed to identifying early biomarker of diabetic foot ulcers (DFU). Pro-inflammatory and anti-inflammatory molecules play a role in the chronic inflammation associated with diabetic foot ulcers (DFU).

This study aims to find the association between ApoA1, IL-10, TNF-α and diabetic foot ulcers, and whether their levels can assess the severity of the disease.

Two groups, diabetic mellitus without foot ulcers and diabetes with foot ulcers were recruited for the study. Detailed clinical history was obtained and blood was collected to measure TNF-α , IL-10 and Apo A1. The association between variables was analysed using Pearson correlation test. ROC analysis was used to identify cut-off values of ApoA1, IL-10 and TNF-α in diabetes patients with foot ulcers.

The presence of pro-inflammatory parameter, TNF-α , was higher and anti-inflammatory biomarkers, HDL, ApoA1 and IL-10 were lower in patients of DFU than those without foot ulcers (p < 0.001). Increasing age, smoking, retinopathy, eGFR and inflammatory biomarkers like low levels of ApoA1 (p < 0.005) and IL-10 (p < 0.001) significantly contributed to the development of diabetic foot ulcers. ROC curve identified the cut-off for ApoA1 and IL-10 as 89.82mg/dL and 78.80pg/mL respectively.

In the light of this study, ApoA1 has the potential to predict DFU. The finding proposes IL-10 (b = -0.37, p < 0.001) could be considered in stratifying DFU as per its severity.