Risk factors and a predictive model of diabetic foot in hospitalized patients with type 2 diabetes.

IF 4.2 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

World Journal of Diabetes Pub Date : 2025-03-15 DOI:10.4239/wjd.v16.i3.95644

Ming-Zhuo Li, Fang Tang, Ya-Fei Liu, Jia-Hui Lao, Yang Yang, Jia Cao, Ru Song, Peng Wu, Yi-Bing Wang

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Abstract

Background: The risk factors and prediction models for diabetic foot (DF) remain incompletely understood, with several potential factors still requiring in-depth investigations.

Aim: To identify risk factors for new-onset DF and develop a robust prediction model for hospitalized patients with type 2 diabetes.

Methods: We included 6301 hospitalized patients with type 2 diabetes from January 2016 to December 2021. A univariate Cox model and least absolute shrinkage and selection operator analyses were applied to select the appropriate predictors. Nonlinear associations between continuous variables and the risk of DF were explored using restricted cubic spline functions. The Cox model was further employed to evaluate the impact of risk factors on DF. The area under the curve (AUC) was measured to evaluate the accuracy of the prediction model.

Results: Seventy-five diabetic inpatients experienced DF. The incidence density of DF was 4.5/1000 person-years. A long duration of diabetes, lower extremity arterial disease, lower serum albumin, fasting plasma glucose (FPG), and diabetic nephropathy were independently associated with DF. Among these risk factors, the serum albumin concentration was inversely associated with DF, with a hazard ratio (HR) and 95% confidence interval (CI) of 0.91 (0.88-0.95) (P < 0.001). Additionally, a U-shaped nonlinear relationship was observed between the FPG level and DF. After adjusting for other variables, the HRs and 95%CI for FPG < 4.4 mmol/L and ≥ 7.0 mmol/L were 3.99 (1.55-10.25) (P = 0.004) and 3.12 (1.66-5.87) (P < 0.001), respectively, which was greater than the mid-range level (4.4-6.9 mmol/L). The AUC for predicting DF over 3 years was 0.797.

Conclusion: FPG demonstrated a U-shaped relationship with DF. Serum albumin levels were negatively associated with DF. The prediction nomogram model of DF showed good discrimination ability using diabetes duration, lower extremity arterial disease, serum albumin, FPG, and diabetic nephropathy (Clinicaltrial.gov NCT05519163).

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2型糖尿病住院患者糖尿病足的危险因素及预测模型

背景：糖尿病足（DF）的危险因素和预测模型尚不完全清楚，一些潜在因素仍需要深入研究。目的：确定新发DF的危险因素，并为住院2型糖尿病患者建立可靠的预测模型。方法：纳入2016年1月至2021年12月住院的6301例2型糖尿病患者。采用单变量Cox模型、最小绝对收缩和选择算子分析来选择合适的预测因子。利用限制三次样条函数探讨了连续变量与DF风险之间的非线性关联。进一步采用Cox模型评价危险因素对DF的影响。通过测量曲线下面积（AUC）来评价预测模型的准确性。结果：75例糖尿病住院患者发生DF。DF的发病密度为4.5/1000人年。长期的糖尿病、下肢动脉疾病、较低的血清白蛋白、空腹血糖（FPG）和糖尿病肾病与DF独立相关。在这些危险因素中，血清白蛋白浓度与DF呈负相关，风险比（HR）和95%可信区间（CI）为0.91 (0.88 ~ 0.95)（P < 0.001）。此外，FPG水平与DF呈u型非线性关系。校正其他变量后，FPG < 4.4 mmol/L和≥7.0 mmol/L的hr和95%CI分别为3.99 (1.55 ~ 10.25)（P = 0.004）和3.12 (1.66 ~ 5.87)(P < 0.001)，均高于中档水平（4.4 ~ 6.9 mmol/L）。预测3年DF的AUC为0.797。结论：FPG与DF呈u型关系。血清白蛋白水平与DF呈负相关。糖尿病病程、下肢动脉病变、血清白蛋白、FPG、糖尿病肾病等因素对DF的预测均具有较好的判别能力（Clinicaltrial.gov NCT05519163）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

自引率

2.40%

发文量

909

期刊介绍： The WJD is a high-quality, peer reviewed, open-access journal. The primary task of WJD is to rapidly publish high-quality original articles, reviews, editorials, and case reports in the field of diabetes. In order to promote productive academic communication, the peer review process for the WJD is transparent; to this end, all published manuscripts are accompanied by the anonymized reviewers’ comments as well as the authors’ responses. The primary aims of the WJD are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in diabetes. Scope: Diabetes Complications, Experimental Diabetes Mellitus, Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus, Diabetes, Gestational, Diabetic Angiopathies, Diabetic Cardiomyopathies, Diabetic Coma, Diabetic Ketoacidosis, Diabetic Nephropathies, Diabetic Neuropathies, Donohue Syndrome, Fetal Macrosomia, and Prediabetic State.