Naemi Roozbeh, Chockalingam Nachiappan, Lutale Janet K, Abbas Zulfiqarali G
School of Health Science and Wellbeing, Staffordshire University, Stoke On Trent, UK.
School of Health and Society, University of Salford, Manchester, UK.
J Diabetes Investig. 2024 Aug;15(8):1094-1104. doi: 10.1111/jdi.14193. Epub 2024 Apr 3.
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.
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.
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.
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.
目的/引言：本研究旨在评估患者是否可分为不同层次，并探讨这些层次是否与糖尿病足并发症风险相对应。
本研究纳入了2284名（1310名男性，974名女性）患者的28项人口统计学、血管、神经和生物力学指标。采用两步聚类分析技术将患者分为具有相似特征的组。
仅识别出两个不同的组：第1组（n = 1199；669名男性，530名女性）和第2组（n = 1072；636名男性，436名女性）。从连续变量来看，分组的最重要预测因素为：踝部振动觉阈值（16.9±4.1V对31.9±7.4V）；拇趾振动觉阈值（16.1±4.7V对33.1±7.9V）；膝部振动觉阈值（18.2±5.1V对30.1±6.5V）；对冷（29.2±1.1°C对26.7±0.7°C）和热（35.4±1.8°C对39.5±1.0°C）刺激的平均温度觉阈值，以及足部对热刺激的平均温度耐受阈值（43.4±0.9°C对46.6±1.3°C）。从分类变量来看，仅发现触觉减退具有最高水平的重要性：触觉正常者中87.4%在第1组；而第2组分别包含触觉减退、高度减退和无触觉者的95.1%、99.3%和90.5%。此外，神经病变（单丝检查）是分组的一个中等重要预测因素（重要性水平0.52），第1组中26.2%的参与者有神经病变，而第2组中有73.5%的参与者有神经病变。随访期间第2组的溃疡发生率比第1组高近五倍。
温度觉、振动觉和触觉减退被证明是将患者分为两组的最强因素，其中一组未来足部溃疡的风险几乎是另一组的5倍。
