The Wound-healing Study (WHY) in people with diabetes

GA-CDRC Investigators:

Andre Greenidge, Amy Browne, Kim Quimby, Angela Rose, Ian Hambleton, Anselm Hennis, Clive Landis (Principal Investigator)

External Investigators:

DH Harrison, Durham University, UK. 


Funding Obtained:

-Barbados Diabetes Foundation/Medicor Foundation “Diagnostic testing for hemoglobinmediated risk in diabetic vascular disease“ US $ 192,555 (5.2007 – 11.2010)
-Mr. Edmund Cohen ? Laboratory Core Support US $ 99,200 (11.2007 – 12.2012)
-Peter D. Cohen Charitable Trust – Laboratory Core Support US $ 9,213 (02.2015 –02.2016)
-Destiny Group of Companies, Ontario, Canada US $ 120,000 (7.2010)

Start Date:


End Date:




The Barbados studies of amputation in people with diabetes (1999 – 2003) revealed an amputation rate in women second only to the Navajo Indians in Arizona and 55% mortality five years post-amputation, the worst in the recorded medical literature. The high rate of amputation and mortality following lower extremity amputations identified in the Barbados studies of amputation highlights the need to mount more effective prevention programmes in
our population. The WHY study aims to investigate novel diagnostic approaches to estimating risk of diabetic foot, based on genetic and vascular predisposing factors. The underpinning idea is that while persons with diabetes can mount a good inflammatory response they cannot resolve
it and progress towards wound healing. The hypothesis investigated is that in addition to conventional socio-demographic and lifestyle factors, genetic and vascular traits in the population may predispose Barbadians to persistent inflammation and cytodestructive oxidative
radical production in the bloodstream and tissues. Primary Objective 1: To determine whether the haptoglobin 2-2 gene polymorphism (linked with excess heme-mediated oxidative radical generation) or the P46L TRAPS polymorphism (TRAPS is the TNF Receptor-Associated Periodic
Syndromes, linked with excess TNFa production) are linked to diabetic foot ulceration in a case control study. Primary Objective 2: To determine whether an impaired nitric oxide (NO) vasodilatory response, a measure of endothelial dependent vasodilation, or relative oxygen saturation (rSO2), a measure of microvascular oxygenation, is associated with disturbed wound healing in PWD.


ases are identified as people with diabetes with a current non-healing foot ulcer of duration >30 days. Controls are people with diabetes matched for sex, age and duration of diabetes without a current foot ulcer or a history of foot ulcers. In addition to the primary objectives, secondary objectives examined associations with footwear, diabetes self-care, health economic cost, and laboratory markers of diabetes, lipid profile and kidney injury.

Main Results:

The project saw the development of scanning and genetic testing techniques in the Edmund Cohen Laboratory not previously available in Barbados, along with the necessary human resource development. Papers on the prevalence of the TRAPSP46L gene in a convenient sample of the Barbados population and validation of lightguide spectrophotometry for rSO2 determination on pigmented skin have been published. A further publication extended the
lightguide spectrophotometry technique to sickle foot in a collaboration with the Sickle Cell Unit. Data collection on the WHY study has finished and analysis is ongoing.


Expected Impact:

The completed WHY study will establish whether inherited genetic risk factors and vascular abnormalities detected with scanning devices are associated with non-healing foot wounds in diabetes. We envisage better and earlier identification of patients at risk of diabetic foot, with health benefits for Barbadians in particular and the diaspora generally.

Next Steps / Future Plans:

none to date.

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