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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引用次数: 0
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).
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.