Analysis of risk factors for foot ulcers in diabetes patients with neurovascular complications

BACKGROUND: Diabetic foot ulcers (DFU), characterized by open sores or wounds primarily occurring on the feet of diabetes patients, are a serious and highly morbid complication of long-standing diabetes, accounting for significant morbidity and mortality. These ulcers develop when diabetes damages both nerves and blood vessels, a combination known as neurovascular complications. Neurovascular disease is a well-established risk factor. While studies have extensively examined risk factors for DFU, few have specifically focused on patients with diabetic neurovascular disease. Therefore, we assess the prevalence and risk factors for DFU in diabetic patients with established neurovascular complications. METHODS: This study analyzed data from 6722 patients with diabetic neurovascular disease aged over 18 years old from the Southern Medical University Nanfang Hospital (SMUNFH) database (2018-2023) and 2689 patients with the same condition and age range from the National Institutes of Health (NIH) Integrated Surveillance System (NIS) database (2017-2019). The incidence of DFU was determined using information from the NIS database and SMUNFH databases. A binary logistic regression model was employed to explore the risk factors for DFU. RESULTS: The incidence of DFU among neurovascular disease patients was 13.4% at SMUNH and 25.9% in the NIS Asian population. Multiple regression analysis identified several factors associated with DFU in the SMUNH database, including diabetic retinopathy, diabetic nephropathy, osteomyelitis, coronary heart disease, tinea pedis (fungal foot infection), sepsis, ability to sense a 128 Hz tuning fork (both left and right sides), C-reactive protein (CRP) levels, and urinary albumin-to-creatinine ratio (ACR). Analysis of NIS data revealed that in the broader Asian population, peripheral vascular disorders and osteomyelitis were associated with DFU. CONCLUSION: The prevalence of DFU is higher in Asia than in China. Focusing on peripheral vascular disorders and osteomyelitis can effectively reduce the prevalence of DFU in the Asian population while addressing diabetic retinopathy, diabetic nephropathy, osteomyelitis, coronary heart disease, tinea pedis, ability to sense a 128 Hz tuning fork, CRP levels, and urinary ACR can be effective in China.