Immunological and Metabolic Biomarkers in Diabetic Foot Ulcers: A Comparative Cross-Sectional Study

Background: Diabetic foot ulcers (DFUs) are among the most disabling and expensive complications of diabetes mellitus, which occur as a result of a combination of metabolic dysfunction, vascular dysfunction, and immune dysregulation. Although increased awareness has been reported, the immunological processes that distinguish between patients with and without active ulceration are yet to be fully described. Objective: The purpose of the study was to compare and assess the glycemic indices, lipid profiles, and a group of inflammatory and immunological biomarkers interleukin-18 (IL-18), tumor necrosis factor-beta (TNF- beta), interleukin-10 (IL-10), basic fibroblast growth factor (BFGF), and C- reactive protein (CRP) across three well-defined clinical groups. Methods: The study adopted a comparative cross-sectional design and included 150 participants, who were stratified as follows: patients with confirmed DFU (n=50), diabetic patients without foot ulcers (n=50) and age and sex matched healthy controls (n=50). The results of the biochemical and immunological measurement were taken on the basis of fasting venous blood samples and the analysis of them with the help of standardized measurements. Results: DFU patients exhibited markedly elevated fasting glucose (192±35 mg/dL) and HbA1c (9.1±1.2%) relative to healthy controls (P<0.001). Dyslipidemia, evidenced by elevated total cholesterol, triglycerides, and low-density lipoprotein (LDL), was observed across both diabetic groups. Pro-inflammatory markers CRP (12.5±4.3 mg/L), IL-18 (340±55 pg/mL), and TNF-β (58±12 pg/mL) were significantly higher in DFU patients than in both comparator groups (P<0.001). Concurrently, IL-10 and BFGF levels were elevated in DFU patients, suggesting a compensatory anti-inflammatory response. Conclusion: DFU is a two-fold immunological burden of increased pro-inflammatory signaling and impaired reparative response. Incorporation of inflammatory biomarkers with glycemic monitoring on a regular basis can lead to a more targeted therapeutic treatment of diabetic foot complications and risk stratification earlier.