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

Authors

  • Samah A. Mohammed Department of Clinical Chemistry, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
  • Seifeldeen Ahmed Mohamed Department of Clinical Chemistry, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
  • Hisham N. Altayeb Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Saudi Arabia
  • Ammar Ebrahim Consultants unit, Research and Consulting Institute, King Faisal University, Al-Ahsa, Saudi Arabia
  • Mariam Abbas Ibrahim Department of Clinical Chemistry, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan

DOI:

https://doi.org/10.47419/bjbabs.v7i3.459

Keywords:

Oxidative stress, Diabetic foot ulcer, Total antioxidant capacity, malondialdehyde, Reduced glutathione

Abstract

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 was
assessed 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 higher
probability 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. 

Downloads

Download data is not yet available.

References

[1] Kovács, N.; Shahin, B.; Andrade, C.A.S.; Mahrouseh, N.; Varga, O. Lifestyle and metabolic risk factors, and diabetes mellitus prevalence in European countries from three waves of the European Health Interview Survey. Sci. Rep. 2024; 14(1): 11623. https://doi.org/10.1038/s41598-024-62122-y

[2] Oo, A.; Lwin, O.; Kanneppady, S.; Skanneppady, S. Oxidative stress marker and fibrinogen level as indicators of severity of diabetic foot ulcer. NUJHS. 2017; 7: 31–36.

[3] Sadati, S.; Radfar, M.; Hamidi, A.; Abdollahi, M.; Qorbani, M.; Esfahani, E., et al. Association between the polymorphism of Glu298Asp in exon 7 of the eNOS gene with foot ulcer and oxidative stress in adult patients with type 2 diabetes. Can. J. Diabetes. 2017; 42; 18–22. https://doi.org/10.1016/j.jcjd.2017.03.001

[4] Wang, Z.; Tan, X.; Xue, Y.; Xiao, C.; Yue, K.; Lin, K., et al. Smart diabetic foot ulcer scoring system. Sci. Rep. 2024. 14, 11588. https://doi.org/10.1038/s41598-024-62076-1

[5] Mariadoss, A.; Sivakumar, A.; Lee, CH.; Kim, S. Diabetes mellitus and diabetic foot ulcer: etiology, biochemical and molecular based treatment strategies via gene and nanotherapy. Biomed. Pharmacother. 2022; 151: 113–134. https://doi.org/10.1016/j.biopha.2022.113134

[6] Rahimi, R.; Nikfar, S.; Larijani, B.; Abdollahi, M. 2005 A review on the role of antioxidants in the management of diabetes and its complications. Biomed. Pharmacother. 59: 365–373. https://doi.org/10.1016/j.biopha.2005.07.002

[7] Da Costa, A.; Garcia-Bailo, B.; Badawi, A.; El-Sohemy, A. Genetic determinants of dietary antioxidant status. Prog. Mol. Biol. Transl. Sci. 2012; 108: 179–200. https://doi.org/10.1016/B978-0-12-398397-8.00008-3

[8] Karunakaran, U.; Park, G. A systematic review of oxidative stress and safety of antioxidants in diabetes: focus on islets and their defense. Diabetes Metab. J. 2013; 37: 106–112. https://doi.org/10.4093/dmj.2013.37.2.106

[9] Saeidnia, S.; Abdollahi, M. Toxicological and pharmacological concerns on oxidative stress and related diseases. Toxicol. Appl. Pharmacol. 2013; 273: 442–455. https://doi.org/10.1016/j.taap.2013.09.031

[10] Rashid, K.; Sinha, K.; derSil, P. An update on oxidative stress-mediated organ pathophysiology. Food Chem. Toxicol. 2013; 62: 584–600. https://doi.org/10.1016/j.fct.2013.09.026

[11] Altoum, A.; Sadig, M. Assessment of serum levels of malondialdehyde, antioxidant vitamin (A,E,C), and lipid profile in Sudanese with type 2 diabetes mellitus. Sch. J. App. Med. Sci. 2015; 3: 2322–2326.

[12] Sen, K.; Roy, S. Redox signals in wound healing. Biochim. Biophys. Acta - Gen. Subj. 2008; 1780: 1348–1361. https://doi.org/10.1016/j.bbagen.2008.01.006

[13] Schafer, M.; Werner, S. Oxidative stress in normal and impaired wound repair. Pharmacol. Res. 2008; 58: 165–171. https://doi.org/10.1016/j.phrs.2008.06.004

[14] Sen, K. Wound healing essentials: let there be oxygen. Wound Repair Regen. 2009; 17: 1–8. https://doi.org/ 10.1111/j.1524-475X.2008.00436.x

[15] Dunnill, C.; Patton, T.; Brennan, J.; Barrett, J.; Dryden, M.; Cooke, J. et al. Reactive oxygen species (ROS) and wound healing: the functional role of ROS and emerging ROS-modulating technologies for augmentation of the healing process. Int. Wound J. 2017; 14: 89–96. https://doi.org/10.1111/iwj.12557

[16] Bid, K.; Konwar, R.; Saxena, M.; Chaudhari, P.; Agrawal, G.; Banerjee, M. Association of glutathione S-transferase (GSTM1, T1 and P1) gene polymorphisms with type 2 diabetes mellitus in north Indian population. J. Postgrad. Med. 2010; 56: 176–181. https://doi.org/10.4103/0022-3859.68633

[17] Katerji, M.; Filippova, M.; Hughes, P. Approaches and methods to measure oxidative stress in clinical samples: research applications in the cancer field. Oxid. Med. Cell. Longev. 2019; 1279250. https://doi.org/10.1155/2019/1279250

[18] Awadalla, H.; Noor, S.; Elmadhoun, W.; Almobarak, A.; Elmak, N.; Abdelaziz, S., et al. Diabetes complications in Sudanese individuals with type 2 diabetes: over-looked problems in Sub-Saharan Africa? Diabetes Metab. Syndr.: Clin. Res. Rev. . 2017; 11: 1047–1051. https://doi.org/10.1016/j.dsx.2017.07.039

[19] Almobarak, A.; Awadalla, H.; Osman, M.; Ahmed, M. Prevalence of diabetic foot ulceration and associated risk factors: an old and still major public health problem in Khartoum, Sudan? Ann. Transl. Med. 2017; 5: 340. https://doi.org/10.21037/atm.2017.07.01

[20] Yousif, S.; Abdalla, M.; Elmahdi, E. Oxidant/antioxidant status of Sudanese type II diabetic patients with multiple complications. J. Diabetol., 2019; 10: 69–75. https://doi.org/10.4103/jod.jod_16_18

[21] Kalkan, I.; and Suher, M. The relationship between the level of glutathione, impairment of glucose metabolism and complications of diabetes mellitus. Pak. J. Med. Sci. 2013; 29: 938–942. https://doi.org/10.12669/pjms.294.2859

[22] Suresh, D.; Annam, V.; Pratibha, K.; Prasad, B. Total antioxidant capacity—a novel early biochemical marker of oxidative stress in HIV infected individuals. J. Biomed. Sci. 2009; 16: 61. https://doi.org/10.1186/1423-0127-16-61

[23] Shabalala, S.; Johnson, R.; Basson, A.; Ziqubu, K.; Hlengwa, N.; Mthembu, S., et al. Detrimental effects of lipid peroxidation in type 2 diabetes: exploring the neutralizing influence of antioxidants. Antioxidants. 2022; 11: 2071. https://doi.org/10.3390/antiox11102071

[24] Tulead, S. Glutathione, vitamin C, malondialdehyde oxidized low-density lipoprotein and lipid profile levels in type 2 diabetic Iraqi males. Nahrain J. Sci. 2016; 19: 48–55. https://doi.org/10.22401/JNUS.19.1.06

[25] Ganjifrockwala, F.A.; Joseph, J.T.; George, G. Decreased total antioxidant levels and increased oxidative stress in South African type 2 diabetes mellitus patients. J. Endocrinol. Metab. Diabetes S. Afr. 2017; 22: 21–25. https://doi.org/10.1080/16089677.2017.1324590

[26] Awni, N.; Ahmed, T.; Sarhat, E.; Ali, N.; Abass, K. Altered serum levels of melatonin, antioxidant enzymes and oxidative stress in individuals with diabetes mellitus type 2. Rev. Latinoam. Hipertens. 2022; 17: 138–141.

[27] Opara, E.; Rahman, E.; Soliman, S.; Kamel, W.; Souk, S.; Lowe, J., et al. Depletion of total antioxidant capacity in type 2 diabetes. Metabolism. 1999; 48: 1414–1417. https://doi.org/10.1016/S0026-0495(99)90152-X

[28] Rani, A.; Mythili, S. Study on total antioxidant status in relation to oxidative stress in type 2 diabetes melli-tus. J. Clin. Diagn. Res. (2014; 8: 108–110. https://doi.org/10.7860/JCDR/2014/7603.4121

[29] Lawal, N.; Akuyam, A.; Ahmad, B. Relationship between serum malondialdehyde (MDA) levels and cardiovascular risk factors in diabetic patients in Zaria, Kaduna State, Nigeria. BJMLS. 2022; 7: 41–50. https://doi.org/10.4314/sokjmls.v7i2.2

[30] Zavar-Reza, J.; Shahmoradi, H.; Mohammadyari, A.; Mohammadbeigi, M.; Hosseini, R.; Vakili, M., Barabadi, T., et al. Evaluation of malondialdehyde (MDA) in type 2 diabetic patients with coronary artery disease (CAD). J. Biol. Today’s World. 2014. 3: 129–132. https://doi.org/10.15412/J.JBTW.01030602

[31] Soliman, A. Blood lipid peroxidation (superoxide dismutase, malondialdehyde, glutathione) levels in Egyptian type 2 diabetic patients. Singap. Med. J. 2008: 49: 129–136.

[32] Hou, Y.; Lin, M.; Qiu, X.; He, M.; Zhang, Y.; Guo, F. Effect of type-2 diabetes mellitus in retinopathy patients on MDA, SOD activity and its correlation with HbA1c. Braz. Arch. Biol. Technol. 2021; 64: 21200075. https://doi.org/10.1590/1678-4324-2021200075

[33] Manohar, S.; Vaikasuvu, S.; Deepthi, K.; Sachan, A.; Narasimha, S. An association of hyperglycemia with plasma malondialdehyde atherogenic lipid risk factors in newly diagnosed type 2 diabetic patients. J. Res. Med. Sci. 2013; 18: 89–93.

[34] Bhutia, Y.; Ghosh, A.; Sherpa, M.; Pal, R.; Mohanta, P. Serum malondialdehyde level: surrogate stress marker in Sikkimese diabetics. J. Nat. Sci. Biol. Med. 2011; 2: 107–112. https://doi.org/10.4103/0976-9668.82309

Additional Files

Published

10-07-2026

How to Cite

Assessment of Oxidative Stress Status in Sudanese patients with Diabetic Foot Ulceration: Highlighting Total Antioxidant Capacity, Reduced Glutathione, and Malondialdehyde Biomarkers. (2026). Baghdad Journal of Biochemistry and Applied Biological Sciences, 7(3), 221-227. https://doi.org/10.47419/bjbabs.v7i3.459

Share