Impact of diabetes mellitus on adenolymphangitis episodes in patients with filarial lymphedema—Towards an integrated care approach

Nikita Kubal, Sowmiya Manavalan, Vijayakumar Balakrishnan, Nileshkumar Elangovan, Danapriyaa Dharmalingam and Vijesh Sreedhar Kuttiatt

PLOS Neglected Tropical Diseases, 2025, vol. 19, issue 9, 1-14

Abstract: Background: Filarial lymphedema, caused by lymphatic filariasis, is characterized by chronic swelling and recurrent skin infections. Acute adenolymphangitis (ADL) episodes significantly exacerbate morbidity. Diabetes mellitus (DM) increases susceptibility to infections; however, the relationship between diabetes and ADL frequency and severity in filarial lymphedema patients remains unclear. This study investigated the influence of diabetes on ADL attacks and identified predictors influencing ADL episodes in patients with filarial lymphedema. Methodology/Principal findings: This case-control study analyzed data from 166 patients (79 diabetic, 87 non-diabetic) attending a filariasis management clinic in Puducherry, India. Sociodemographic data, clinical characteristics, ADL frequency, severity, and adherence to morbidity management and disability prevention (MMDP) practices were collected. Univariate and multivariate logistic regression analyses examined the association between diabetes mellitus and ADL episodes. Diabetes status did not significantly influence ADL frequency or severity. However, lymphedema severity and intertrigo presence emerged as significant predictors of increased ADL attack risk. Home-based care was associated with increased ADL frequency, suggesting potential inadequacies in current self-care practices. Conclusions: This study emphasizes the importance of integrated care approaches addressing both diabetes and lymphedema management. Lymphedema severity and intertrigo management should be prioritized in patient care to mitigate ADL risks. Strengthening home-care education and protocols is essential for improving ADL outcomes. Future research should explore structured community-based and prospective studies to clarify diabetes management’s potential protective role and further enhance the quality of care for affected individuals. Author summary: Lymphatic filariasis causes filarial lymphedema, a chronic condition characterized by swelling and recurrent skin infections known as acute adenolymphangitis (ADL). Diabetes mellitus (DM) is associated with increased susceptibility to infections, raising concerns about its potential impact on ADL episodes. This study examined whether diabetes influences ADL frequency or severity among patients with filarial lymphedema in Puducherry, India. Contrary to expectations, diabetes mellitus did not significantly affect ADL outcomes, although advanced lymphedema and intertrigo significantly increased ADL risk. Additionally, home-based care was linked to more frequent ADL episodes, suggesting the need for improved home-care practices. Foot care is the common point in diabetes and lymphedema care. These findings highlight the necessity for integrated healthcare approaches and better education on self-care management to reduce ADL attacks and improve patient outcomes.

Date: 2025
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pntd00:0013486

DOI: 10.1371/journal.pntd.0013486

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