Diagnostic and Prognostic Value of Inflammatory Markers (l IL-6) in Predicting Diabetic Foot Progression in Patients with Type 2 Diabetes at Al-Wahda Hospital

• MOHAMMED MURJIA ALI QASSIM

  Darna University ،Medicine Faculty،Surgical department، Darna, Libya

  Author

Diabetic foot disease is a major complication of type 2 diabetes mellitus (T2DM), with inflammation contributing to tissue damage and delayed wound healing. This study evaluated serum interleukin-6 (IL-6) as a potential biomarker of diabetic foot disease and its progression. An observational study included 120 patients with T2DM, comprising 60 patients without diabetic foot disease and 60 with diabetic foot disease, who underwent clinical assessment and serum IL-6 measurement using ELISA. Patients with diabetic foot disease had significantly higher IL-6 levels than controls (19.01 ± 5.95 vs. 4.98 ± 2.00 pg/mL, p < 0.001). IL-6 was strongly correlated with diabetic foot disease (Spearman’s ρ = 0.864, p < 0.001) and CRP (r = 0.762, p < 0.001), but did not differ significantly across Wagner grades (p = 0.786) or during 3–6 months of follow-up (p = 0.631). ROC analysis showed excellent diagnostic performance for IL-6 (AUC = 0.999), exceeding that of CRP (0.944), ESR (0.915), and WBC (0.851). Higher IL-6 levels were also associated with diabetic foot disease in logistic regression analysis (OR = 14.09, 95% CI: 1.29–153.88, p = 0.030). Serum IL-6 may therefore serve as a valuable biomarker for identifying patients with T2DM at increased risk of diabetic foot disease and may support early clinical risk stratification and management

Al-Sharoofi, Z. H., Alshammari, M. M., & Abdel Zaid, M. (2026). Diagnostic rating (value) of serum IL6, IL-17A, and TLR-2 levels for detecting infected diabetic foot. Egyptian Journal of Medical Microbiology, 35(1). DOI: https://doi.org/10.21608/ejmm.2025.391383.1689

Chen, H., Mei, S., Zhou, Y., & Dai, J. (2024). Systematic review and meta-analysis of the diagnostic accuracy of inflammatory markers for infected diabetic foot ulcer. Journal of Tissue Viability. DOI: https://doi.org/10.1016/j.jtv.2024.09.007

Chen, H., Zhou, Y., & Dai, J. (2026). Association between three systemic inflammatory biomarkers and diabetic foot ulcer: A cross-sectional study and a clinical retrospective study. Mediators of Inflammation, 2026, 7709529. DOI: https://doi.org/10.1155/mi/7709529

Chen, T., Yu, J., Wang, J., Chang, Q., & Qian, C. (2020). Elevated serum levels of Lp-PLA2 and IL-18 are associated with progression of diabetic foot ulcers. Clinical Laboratory, 66(10), 1961. DOI: https://doi.org/10.7754/Clin.Lab.2020.191253

Dharmadas, S., Kumar, H., Pillay, M., Sukumaran Mangalanandan, T., Vivek, L., Praveen, V. P., & Bal, A. (2024). Biomarkers for early detection of Charcot arthropathy: A prospective study on type 2 diabetes patients with severe neuropathy. Foot & Ankle International, 45(2), 175–178. DOI: https://doi.org/10.1177/10711007231213645

Ding, S., Gong, Y., Song, M., Guo, Z., Sun, R., Liu, Y., & Ge, Z. (2026). Factors associated with the prognosis of diabetic foot ulcers treated with silver ion hydrogel dressings combined with negative pressure wound therapy and the construction of a risk prediction model: A study of two machine learning methods, LASSO and random forest algorithms. International Journal of Diabetes in Developing Countries, 1–15. DOI: https://doi.org/10.1007/s13410-026-01636-9

Dmitriyeva, M., Kozhakhmetova, Z., Urazova, S., Kozhakhmetov, S., Turebayev, D., & Toleubayev, M. (2022). Inflammatory biomarkers as predictors of infected diabetic foot ulcer. Current Diabetes Reviews, 18(6), 4–11. DOI: https://doi.org/10.2174/1573399817666210928144706

Kaleli, S., Varim, C., Nalbant, A., Yazar, H., & Akdoğan, M. (2019). Interleukins as a marker of inflammation in diabetic foot syndrome and type 2 diabetes mellitus. Bezmialem Science. DOI: https://doi.org/10.14235/bas.galenos.2017.2077

Korkmaz, P., Koçak, H., Onbaşı, K., Biçici, P., Özmen, A., Uyar, C., & Özatağ, D. M. (2018). The role of serum procalcitonin, interleukin-6, and fibrinogen levels in differential diagnosis of diabetic foot ulcer infection. Journal of Diabetes Research, 2018, 7104352. DOI: https://doi.org/10.1155/2018/7104352

Lee, H., Brown, A., Torrence, G. M., Rothenberg, G. M., Girgis, C., Anwar, N., ... & Schmidt, B. M. (2026). Biomarkers in diabetic foot. Clinics in Podiatric Medicine and Surgery, 43(2), 195–209. DOI: https://doi.org/10.1016/j.cpm.2025.12.007

Mitrea, A., Ștefan, A. G., Vladu, I. M., Clenciu, D., Stan, S. I., Efrem, I. C., ... & Țenea-Cojan, T. Ș. (2025). A composite score of insulin resistance and inflammation biomarkers for predicting lower limb complications in type 2 diabetes mellitus. International Journal of Molecular Sciences, 26(24), 11859. DOI: https://doi.org/10.3390/ijms262411859

Mohamed, A. A., Hussein, M. A. E., Hanna, I. N., Nashwan, A. J. J., Saleh, M., Wahed, W. Y. A., ... & Hafez, W. (2024). The potential impact and diagnostic value of inflammatory markers on diabetic foot progression in type II diabetes mellitus: A case–control study. Medicina Clínica, 162(9), e33–e39. DOI: https://doi.org/10.1016/j.medcli.2024.01.009

Mohsin, S. M., & Al-Shekerchi, A. J. (2024). Evaluation of some immunological parameters associated with diabetic foot infection in Kerbala Governorate. Journal of Scientific Research in Medical and Biological Sciences, 5(3), 144–159.

Mureșan, A. V., Tomac, A., Opriș, D. R., Bandici, B. C., Coșarcă, C. M., Covalcic, D. C., ... & Tilinca, M. C. (2023). Inflammatory markers used as predictors of subclinical atherosclerosis in patients with diabetic polyneuropathy. Life, 13(9), 1861. DOI: https://doi.org/10.3390/life13091861

Pan, Z., Wang, X., Que, H., & Rong, J. (2025). Identification of risk factors for poor prognosis and analysis of their correlation with ulcer severity in diabetic foot patients undergoing digital subtraction angiography-guided intervention. Diabetes, Metabolic Syndrome and Obesity, 4803–4813. DOI: https://doi.org/10.2147/DMSO.S555974

Pichu, S., Patel, B. M., Apparsundaram, S., & Goyal, R. K. (2017). Role of biomarkers in predicting diabetes complications with special reference to diabetic foot ulcers. Biomarkers in Medicine, 11(4), 377–388. DOI: https://doi.org/10.2217/bmm-2016-0205

Qin, Y., & Deng, S. (2025). Inflammation, diabetic foot and related treatments. Frontiers in Endocrinology, 16, 1676621. DOI: https://doi.org/10.3389/fendo.2025.1676621

Sangeeta, S., Siripuram, C., Konka, S., Vaithilingam, K., Periasamy, P., Velu, R. K., ... & Velu, K. (2025). Biomarkers of inflammation, oxidative stress, and endothelial dysfunction in early detection of diabetic foot ulcers. Cureus, 17(4). DOI: https://doi.org/10.7759/cureus.82174

Serban, D., Papanas, N., Dascalu, A. M., Kempler, P., Raz, I., Rizvi, A. A., ... & Ovidiu Costea, D. (2024). Significance of neutrophil to lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in diabetic foot ulcer and potential new therapeutic targets. The International Journal of Lower Extremity Wounds, 23(2), 205–216. DOI: https://doi.org/10.1177/15347346211057742

Shaikh, S. B., Varughese, A., Bhandary, Y., Ismail, H. M., Moosabba, M. S., & Nagane, N. S. (2026). Association of molecular biomarkers with disease severity in diabetic foot ulcers: A case control study. Genetics and Molecular Research. DOI: https://doi.org/10.4238/tn76gq05

Wang, J., Yang, X., Zhou, T., Ma, H., Yuan, X., & Yan, S. (2025). Understanding risk factors and prognosis in diabetic foot ulcers. Open Life Sciences, 20(1), 20251137. DOI: https://doi.org/10.1515/biol-2025-1137

Wang, S., Gao, L., Qin, X., Li, T., Wang, J., & Xie, H. (2025). The prognostic and diagnostic significance of inflammatory markers TNF-α, IL-6, and IFN-γ in evaluating disease severity in diabetic foot infection. Frontiers in Cellular and Infection Microbiology, 15, 1606612. DOI: https://doi.org/10.3389/fcimb.2025.1606612

Wu, J., Raju, B., Zha, P., Gong, H., Ren, Y., Li, Z., Chen, L., Liu, G., Chen, D., Wang, C., & Ran, X. (2023). Characteristics of inflammatory markers in diabetic foot patients and their relationship with prognosis of diabetic foot ulcers. Journal of Sichuan University (Medical Sciences), 54(6), 1233–1238.

Yang, W., Cao, H., Lin, S., & Tian, F. (2025). Investigating serum NRF2 as a screening biomarker and potential therapeutic target in diabetic foot ulcers: A prospective observational study. European Journal of Medical Research, 30(1), 841. DOI: https://doi.org/10.1186/s40001-025-03086-1

Zhou, Y., Zhou, W., Guo, Y., & Hu, C. (2025). Correlation of wound prognosis with serum IL-6, ICAM-1 and sST2 in patients with diabetic foot and construction of a nomogram model. The International Journal of Lower Extremity Wounds, 15347346251345262. DOI: https://doi.org/10.1177/15347346251345262

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