What characteristics are most important in stratifying patients into groups with different risk of diabetic foot ulceration?

Roozbeh Naemi; Nachiappan Chockalingam; Janet K Lutale; Zulfiqarali G Abbas

doi:10.1111/jdi.14193

What characteristics are most important in stratifying patients into groups with different risk of diabetic foot ulceration?

J Diabetes Investig. 2024 Apr 3. doi: 10.1111/jdi.14193. Online ahead of print.

Authors

Roozbeh Naemi^{1

2}, Nachiappan Chockalingam¹, Janet K Lutale³, Zulfiqarali G Abbas^{1

3

4}

Affiliations

¹ School of Health Science and Wellbeing, Staffordshire University, Stoke On Trent, UK.
² School of Health and Society, University of Salford, Manchester, UK.
³ Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
⁴ Abbas Medical Centre, Dar es Salaam, Tanzania.

PMID: 38571302
DOI: 10.1111/jdi.14193

Abstract

Aims/introduction: This study aimed to assess if patients can be divided into different strata, and to explore if these correspond to the risk of diabetic foot complications.

Materials and methods: A set of 28 demographic, vascular, neurological and biomechanical measures from 2,284 (1,310 men, 974 women) patients were included in this study. A two-step cluster analysis technique was utilised to divide the patients into groups, each with similar characteristics.

Results: Only two distinct groups: group 1 (n = 1,199; 669 men, 530 women) and group 2 (n = 1,072; 636 men, 436 women) were identified. From continuous variables, the most important predictors of grouping were: ankle vibration perception threshold (16.9 ± 4.1 V vs 31.9 ± 7.4 V); hallux vibration perception threshold (16.1 ± 4.7 V vs 33.1 ± 7.9 V); knee vibration perception threshold (18.2 ± 5.1 V vs 30.1 ± 6.5 V); average temperature sensation threshold to cold (29.2 ± 1.1°C vs 26.7 ± 0.7°C) and hot (35.4 ± 1.8°C vs 39.5 ± 1.0°C) stimuli, and average temperature tolerance threshold to hot stimuli at the foot (43.4 ± 0.9°C vs 46.6 ± 1.3°C). From categorical variables, only impaired sensation to touch was found to have importance at the highest levels: 87.4% of those with normal sensation were in group 1; whereas group 2 comprised 95.1%, 99.3% and 90.5% of those with decreased, highly-decreased and absent sensation to touch, respectively. In addition, neuropathy (monofilament) was a moderately important predictor (importance level 0.52) of grouping with 26.2% of participants with neuropathy in group 1 versus 73.5% of participants with neuropathy in group 2. Ulceration during follow up was almost fivefold higher in group 2 versus group 1.

Conclusions: Impaired sensations to temperature, vibration and touch were shown to be the strongest factors in stratifying patients into two groups with one group having almost 5-fold risk of future foot ulceration compared to the other.

Keywords: Diabetic foot; Foot ulcer; Stratification.