The predictive value of developing foot ulcers of DNP patients by bipedal dynamic parameters and insulin resist-ance index

LI Heng; ZHANG Cui-lan; BAI Yang

doi:10.13820/j.cnki.gdyx.20240585

Abstract：Objective To explore the predictive value of vibration perception threshold(VPT),maximum plan-tar pressure,and insulin resistance index for the development of foot ulcers in patients with diabetic peripheral neuropathy(DPN)over a one-year follow-up period.Methods The study included 112 patients with diabetic peripheral neuropa-thy who visited our hospital from May 2020 to May 2022.Patients were divided into two groups:DPN group(n=57,50.89％)and diabetic neuropathy with foot ulcer(DNFU)group(n=55,49.11％)based on whether foot ulcers devel-oped during the one-year follow-up.General clinical data and dynamic foot parameters were compared between the groups.Multivariate logistic regression was used to identify independent predictors of foot ulcer development.The relation-ship between VPT,maximum plantar pressure,and insulin resistance index with the development of foot ulcers was ana-lyzed,and ROC curves and decision curves were constructed to evaluate predictive performance and net benefit.Results The DNFU group had significantly higher diabetes duration(7.93±2.21 years vs.6.23±1.85 years,t/P=2.678/0.013),HbA1C levels(8.83±2.23％vs.7.23±2.12％,t/P=4.725/0.000),and insulin resistance index(3.61±0.38 vs.2.87±0.34,t/P=4.882/0.000)than the DPN group(P＜0.05).VPT(12.56±3.22 vs.8.42±1.32,t/P=4.878/0.000)and maximum plantar pressure(2 456.89±322.74 N vs.2228.33±234.42 N,t/P=7.838/0.000)were significantly higher in the DNFU group(P＜0.05).Multivariate logistic regression analysis identified insu-lin resistance index(OR:2.275,95％CI:1.226-3.452,P=0.028),VPT(OR:2.594,95％CI:1.137-3.786,P=0.005),and maximum plantar pressure(OR:2.376,95％CI:1.342-3.567,P=0.017)as independent predic-tors for foot ulcer development(P＜0.05).ROC analysis showed that the area under the curve(AUC)for predicting foot ulcer development was 0.765(95％CI:0.712-0.867)for insulin resistance index,0.834(95％CI:0.782-0.927)for VPT,and 0.811(95％CI:0.775-0.878)for maximum plantar pressure.Decision curve analysis indicated good net benefit for VPT,maximum plantar pressure,and insulin resistance index in predicting foot ulcer development,with the combined prediction model achieving the highest net benefit.Conclusion VPT,maximum plantar pressure,and insulin resistance index are effective predictors of foot ulcer development in diabetic peripheral neuropathy patients over a one-year follow-up period,demonstrating good predictive performance and net benefit.