Identifying At-risk Foot Among Hospitalized Patients With Type 2 Diabetes

Aims: To investigate the prevalence and associated factors of diabetic at-risk foot among hospitalized patients with type 2 diabetes.Methods: A total of 838 hospitalized patients with type 2 diabetes were screened for at-risk foot. Neural and vascular disorders were evaluated by assessing vibration perception thresholds and ankle brachial indexes(ABIs). After excluding 12 patients with abnormally high ABIs, remaining individuals with neural and/or vascular disorder were identified as at-risk patients and further classified into three subtypes: isolated neural disorder, isolated vascular disorder and mixed disorder. Potential associated factors were examined using logistic regression models.Results: In the final sample of 826 individuals, the prevalence of diabetic at-risk foot was30.6%. Among all at-risk patients, isolated neural disorder(69.6%) was more common than mixed(16.2%) or isolated vascular disorder(14.2%). Isolated neural and vascular disorders shared specific risk factors, including age per 20-year increment(odds ratio [95%confidence interval], 3.73 [2.59-5.37], 4.01 [1.98-8.11]), diabetic duration ≥ 10 years(1.69[1.13-2.54], 3.29 [1.49-7.24]) and systolic blood pressure ≥ 140 mm Hg(1.96 [1.31-2.93],2.90 [1.38-6.10]), respectively. In addition, isolated neural disorder was associated with heavy smoking history(2.69 [1.15-6.31]) and increased high-sensitivity C-reactive protein levels(1.30 [1.04-1.62]), respectively. Isolated vascular disorder was linked with decreased HDL cholesterol levels(3.42 [1.31-8.96]) and increased triglycerides levels(2.74[1.26-5.97]), respectively.Conclusions: Diabetic at-risk foot is epidemic among hospitalized patients with type 2diabetes. Aging, long-term diabetes, hypertension, smoking, inflammatory response and dyslipidemia may be associated with the prevalence of diabetic at-risk foot.