Assessment of Oxidative Stress Status in Sudanese patients with Diabetic Foot Ulceration: Highlighting Total Antioxidant Capacity, Reduced Glutathione, and Malondialdehyde Biomarkers

Background: Higher prevalence of diabetes mellitus (DM) has been reported in low- and middle-income countries than high-income countries. Oxidative stress is one of the main pathologies in DM, leading to cellular damage and various related complications.Objective: To evaluate the oxidative stress status of Sudanese patients with diabetic foot ulcers by comparing oxidative stress biomarkers with those of diabetic patients without active DFUs.Methods: A case-control study was conducted in Sudan involving 204 participants, including 102 patients with DFUs and 102 diabetic patients without active DFUs serving as controls. Patients with other physiological hyperglycemic complications were excluded. Oxidative stress status wasassessed by measuring total antioxidant capacity (TAC), reduced glutathione (GSH), and malondialdehyde (MDA). Differences between groups and the odds of elevated biomarker levels were analyzed.Results: A significant higher mean value of total antioxidant capacity (TAC) in controls with diabetes (0.776 mmol/L) compared to their corresponding values in the DFU group (0.740 mmol/L) was recorded. In glutathione reduced (GSH), no significant differences were detected. On the contrary, malondialdehyde (MDA) level was significantly raised in ulcer subjects (4.550 nmol/ mL) when compared to diabetic control subjects (4.021 nmol/L). Diabetic patients had a higherprobability of having high levels of TAC and GSH (odd ratio (OR) = 1.5 and 2.5, respectively), while the ulcer group had a higher likelihood of scoring higher MDA (OR = 0.359).Conclusions: The findings of the study indicated a strong association between glycemic-induced oxidative stress and the development of DFUs.