Assessment of Immunological Biomarkers in Diabetic Patients with and without Foot Ulcers

Ulcers of the foot caused by diabetes (DFU) are among the most severe consequences of diabetes mellitus, significantly diminishing ‎patients’ quality of life and often resulting in persistent infections and potential limb loss. This study aimed to assess the serum levels ‎of four immunological biomarkers: interleukin-10 (IL-10), interleukin-18 (IL-18), tumor necrosis factor-alpha (TNF-α), and basic ‎fibroblast growth factor (bFGF) in patients with diabetes and in patients without foot ulcers, as well as in healthy participants. The ‎study enrolled 90 participants, including diabetic patients with foot ulcers, diabetic patients without ulcers, and healthy controls. ‎Then, the Blood samples were collected and analyzed using ELISA to determine serum concentrations of IL-10, IL-18, TNF-α, and ‎bFGF. Statistical analyses included ANOVA, Duncan's multiple range test, and ROC curve evaluation. The results indicate that IL-18 ‎and TNF-α levels were significantly elevated in both diabetic groups compared to controls (P < 0.001), indicating persistent systemic ‎inflammation. IL-10 levels were significantly higher in diabetics without ulcers than in controls (P < 0.05), suggesting a compensatory ‎anti-inflammatory response. Interestingly, bFGF was significantly elevated in patients with ulcers (P < 0.001), potentially reflecting a ‎local reparative response. ROC analysis revealed that bFGF had high diagnostic accuracy (AUC = 0.809) in differentiating DFU ‎patients from healthy individuals. The finding highlighted that the observed cytokine profiles suggest that DFUs are characterized by ‎an inflammatory–reparative imbalance. Elevated IL-18 and TNF-α indicate sustained inflammation, while reduced IL-10 and ‎altered bFGF levels reflect impaired resolution and tissue repair mechanisms. These markers, particularly bFGF, show promise as ‎potential diagnostic tools for identifying and monitoring DFU progression‎.