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. 2022 Sep;10(5):e002380.
doi: 10.1136/bmjdrc-2021-002380.

Trends in the relation between hyperglycemia correction and active Charcot neuroarthropathy: results from the EPICHAR study

Dured Dardari  1   2 , Sophie Schuldiner  3 , Carole-Anne Julien  4 , Georges Ha Van  5 , Jocelyne M'Bemba  6 , Muriel Bourgeon  7 , Ariane Sultan  8   9 , Marc Lepeut  10 , Sylvie Grandperret-Vauthier  11 , Florence Baudoux  12 , Maud François  13 , Sylvaine Clavel  14 , Jacques Martini  15 , Julien Vouillarmet  16 , Paul Michon  16 , Myriam Moret  17 , Arnaud Monnier  18 , Vaneva Chingan-Martino  19 , Vincent Rigalleau  20   21 , Isabelle Dumont  22 , Laurence Kessler  23   24 , Ionela Stifii  23 , Benjamin Bouillet  25   26 , Pierre Bonnin  27 , Amal Lemoine  28 , Enrique Da Costa Correia  29 , Marie Martine Bonello Faraill  30 , Marie Muller  31 , Marie Cazaubiel  32 , Mohammed Zakarya Zemmache  33 , Agnes Hartemann  34   35
Affiliations

Trends in the relation between hyperglycemia correction and active Charcot neuroarthropathy: results from the EPICHAR study

Dured Dardari et al. BMJ Open Diabetes Res Care. 2022 Sep.

Abstract

Introduction: The pathophysiology of Charcot neuroarthropathy (CN) remains unclear. There are a number of hypotheses but these are not exclusive. In its clinical presentation, this complication intersects with the semiology of diabetic-induced neuropathy, such as peripheral hypervascularization and the appearance of arteriovenous shunt. The EPICHAR study is as yet an unpublished cohort of people living with diabetes complicated by CN (in active or chronic phase). Based on the findings of the EPICHAR study, this study aimed to investigate whether a reduction in the rate of hyperglycemia accompanies the onset of an active phase of CN.

Research design and methods: Hemoglobin A1c (HbA1c) levels were assessed 3 months (M3) and 6 months (M6) before the diagnosis of active CN (M0).

Results: 103 patients living with diabetes and presenting active CN were included between January and December 2019 from the 31 centers participating in this study (30 in France and 1 in Belgium). The mean age of the participants was 60.2±12.2 years; the vast majority were men (71.8%) living with type 2 diabetes (75.5%). Mean HbA1c levels significantly declined between M6 (median 7.70; Q1, Q3: 7.00, 8.55) and M3 (median 7.65; Q1, Q3: 6.90, 8.50) (p=0.012), as well as between M6 and M0 (median 7.40; Q1, Q3: 6.50, 8.50) (p=0.014). No significant difference was found between M3 and M0 (p=0.072).

Conclusions: A significant reduction in HbA1c levels seems to accompany the onset of the active phase of CN.

Trial registration number: NCM03744039.

Keywords: HbA1c; diabetes complications; diagnosis; neuroarthropathy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Mean hemoglobin A1c (HbA1c) levels (mmol/mol) and their evolution at month 6 (M6), month 3 (M3), and month 0 (M0).
Figure 2
Figure 2
Mean hemoglobin A1c (HbA1c) levels (mmol/mol) and their evolution at month 6 (M6), month 3 (M3), and month 0 (M0) according to diabetes type.
See this image and copyright information in PMC

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