The awareness and determinants of diabetic foot ulcer prevention among diabetic patients: Insights from NHANES (2011–2018)

Wang, Xingkai; Xu, Mengying; Meng, Lei; Song, Mingzhi; Jia, Zhuqiang; Zhao, Lin; Han, Xin; Wang, Shouyu; Zong, Junwei; Lu, Ming

doi:10.1016/j.pmedr.2023.102433

Cited by 3 publications

(1 citation statement)

References 24 publications

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“…Besides, diabetes was another important confounder that may have an impact on hypertension and other cardiovascular diseases [ 31 , 32 ]. Anyone who provided a previous diagnosis of diabetes by a physician or health professional was defined as patients with diagnosed diabetes, while those without diagnosed diabetes but with a HbA1c level 6.5% (47.5 mmol/mol) or higher, FPG level 126 mg/dL (7.0 mmol/L) or higher, or 2-h oral glucose tolerance test (OGTT) plasma glucose 200 mg/dL or higher (11.1 mmol/L) tested by laboratory examinations were classified as having undiagnosed diabetes.…”

Section: Methodsmentioning

confidence: 99%

Gender differences in the association between healthy eating index-2015 and hypertension in the US population: evidence from NHANES 1999–2018

Weng,

Mao,

Xie

et al. 2024

BMC Public Health

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Background Diet has long been recognized as an important modifiable risk factor for hypertension. Herein, our research goal was to decipher the association of healthy eating index-2015 (HEI-2015) with hypertension, and to explore potential gender differences. Methods We collected the cross-sectional data of 42,391 participants of the National Health and Nutrition Examination Survey (NHANES) 1999–2018. The association of HEI-2015 with hypertension was estimated using weighted multivariate logistic regression, with restricted cubic spline (RCS) regression being adopted to examine the nonlinearity of this association in both genders, and the stability of the results were examined by sensitivity analysis. We also performed subgroup analysis to detect potential difference in the link between HEI-2015 and hypertension stratified by several confounding factors. Results After eliminating potential confounding bias, the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for hypertension across higher HEI-2015 quartiles were 0.93 (0.85–1.03), 0.84 (0.77–0.93), and 0.78 (0.72–0.86) compared to the lowest quartile, respectively. HEI-2015 was nonlinearly and inversely associated with hypertension in all participants. The gender-specific RCS curves presented a U-shaped correlation in males, while showed a linear and inverse correlation in females. Besides, subgroup analyses showed a lower risk of hypertension in participants who were females, younger than 40 years, Whites, obese, and diabetic patients. Conclusions We determined a nonlinear and inverse association between HEI-2015 and hypertension in the US general population, and revealed a remarkable gender difference when adhering to a HEI-2015 diet for preventing hypertension.

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Section: Methodsmentioning

confidence: 99%

Gender differences in the association between healthy eating index-2015 and hypertension in the US population: evidence from NHANES 1999–2018

Weng,

Mao,

Xie

et al. 2024

BMC Public Health

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Association Between red Cell Distribution Width/Albumin Ratio and Diabetic Lower Extremity Ulcers (DLEU) among US Outpatients in the NHANES: A Retrospective Cross-Sectional Study

Huang,

Wang,

Deng

et al. 2024

The International Journal of Lower Extremity Wounds

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Objective Diabetic foot ulcers are common chronic complications of diabetes mellitus that can lead to amputation and death in severe cases. There is limited research on the relationship between the red cell distribution width/albumin ratio and diabetic lower-extremity ulcers. The few studies that have been conducted have been in single-center inpatient settings and there is limited research in outpatient settings. This study investigated this relationship in adult outpatient clinics in the United States. Methods A retrospective cross-sectional study was conducted with 1624 participants of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Three logistic regression models were developed to assess the association between red cell distribution width/albumin ratio and diabetic lower-extremity ulcers. The ratio was analyzed as a continuous and categorical variable. Stratified analyses were performed based on age, sex, HbA1c level, and body mass index. Results The study included 1624 adults, with a mean age of 65.0 ± 12.0 years, of whom 58.8% were male. The prevalence of diabetic lower-extremity ulcers was 8.0% ( n = 131). Compared with individuals with a lower red cell distribution width/albumin ratio in T1(2.32,2.93), the adjusted OR values for the ratio and ulcers in T2(2.94,3.26), T3(3.27,7.42), and 2.07 (95% CI = 1.19∼3.61), 2.92 (95% CI = 1.63∼5.23). The association between the ratio and ulcers exhibited a non-linear relationship (nonlinear, P = .028). Conclusion These results support the hypothesis of an S-shaped relationship between red cell distribution width/albumin and diabetic lower-extremity ulcers. Monitoring the RDW/Albumin ratio could be crucial for preventing diabetic lower-extremity ulcers in outpatient settings. Regular assessments may help identify high-risk patients early, enabling timely interventions. Future studies should further assess these two factors and their underlying mechanisms.

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Association between anemia and diabetic lower extremity ulcers among US outpatients in the National Health and Nutrition Examination Survey: a retrospective cross-sectional study

Cao,

Wang,

Zhang

et al. 2024

Front. Endocrinol.

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PurposeThe aim of this study was to explore the relationship between hemoglobin levels, anemia and diabetic lower extremity ulcers in adult outpatient clinics in the United States.MethodsA retrospective cross-sectional study was conducted on 1673 participants in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Three logistic regression models were developed to evaluate the relationship between anemia and diabetic lower extremity ulcers. Model 1 adjusted for demographic and socioeconomic variables (age, sex, race and ethnicity, educational level, family income, and marital status). Model 2 included additional health-related factors (BMI, cardiovascular disease, stroke, family history of diabetes, hyperlipidemia, alcohol and smoking status). Model 3 further included clinical and laboratory variables (HbA1c, CRP, total cholesterol, and serum ferritin levels). Stratified analyses were also conducted based on age, sex, HbA1c level, body mass index (BMI), and serum ferritin level.ResultsThe study included 1673 adults aged 40 years and older, with a mean age of 64.7 ± 11.8 years, of whom 52.6% were male. The prevalence of diabetic lower extremity ulcers (DLEU) was 8.0% (136 participants). Anemia was found in 239 participants, accounting for 14% of the study group. Model 1 showed an OR of 2.02 (95% CI=1.28~3.19) for anemia, while Model 2 showed an OR of 1.8 (95% CI=1.13~2.87). In Model 3, the OR for DFU in patients with anemia was 1.79 (95% CI=1.11~2.87). Furthermore, when serum ferritin was converted to a categorical variable, there was evidence of an interaction between DLEU status and serum ferritin in increasing the prevalence of DLEU.ConclusionAfter adjusting for confounding variables, higher levels of anemia were proportionally associated with an increased risk of incident DLEU. These results suggest that monitoring T2DM patients during follow-up to prevent the development of DLEU may be important. However, further prospective studies are needed to provide additional evidence.

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The awareness and determinants of diabetic foot ulcer prevention among diabetic patients: Insights from NHANES (2011–2018)

Cited by 3 publications

References 24 publications

Gender differences in the association between healthy eating index-2015 and hypertension in the US population: evidence from NHANES 1999–2018

Gender differences in the association between healthy eating index-2015 and hypertension in the US population: evidence from NHANES 1999–2018

Association Between red Cell Distribution Width/Albumin Ratio and Diabetic Lower Extremity Ulcers (DLEU) among US Outpatients in the NHANES: A Retrospective Cross-Sectional Study

Association between anemia and diabetic lower extremity ulcers among US outpatients in the National Health and Nutrition Examination Survey: a retrospective cross-sectional study

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