Xing Jia-Hao, Yu Yang, Teng Lin, Hui Xue-Ying, Guo Wei-Guang
Heilongjiang University of Chinese Medicine, Heilongjiang, 150001, China.
Department of Peripheral Vascular Diseases, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, 150001, Heilongjiang, China.
Diabetes Ther. 2025 Jun;16(6):1255-1266. doi: 10.1007/s13300-025-01730-x. Epub 2025 Mar 28.
Diabetic foot ulcers (DFU) are serious complications of diabetes. These ulcers significantly increase the risk of amputations. Many studies have examined how blood heavy metals affect insulin secretion in diabetes. However, research linking blood heavy metal exposure to DFU is limited. This study aims to explore the connection between blood heavy metal exposure and DFU in people with diabetes.
This cross-sectional study used data from the 1999-2004 cycle of the National Health and Nutrition Examination Survey (NHANES). Researchers measured blood levels of lead (Pb) and cadmium (Cd) using inductively coupled plasma mass spectrometry (ICP-MS). Four logistic regression models assessed the relationship between blood heavy metals and the prevalence of DFU. The models adjusted for potential confounding factors. Additionally, smooth curve fitting and piecewise regression analyses were conducted to investigate the correlation further. Subgroup analyses and interaction tests helped evaluate consistency across the general population.
A total of 1664 participants aged 40 years or older with diabetes were included in the final analysis. The average age is 64.66 ± 11.79 years, with 52.52% being male and 47.48% being female. Among these individuals, 135 (8.11%) were diagnosed with DFU. Statistical modeling revealed a significant positive correlation between blood cadmium (Cd) levels and the prevalence of DFU. Specifically, model 4, which was the fully adjusted model, indicated that for each unit increase in blood Cd level, there was a corresponding 64% increase in DFU prevalence [OR = 1.64; 95% CI (1.42-1.89), p = 0.004]. Further analysis through smooth curve fitting demonstrated a significant linear relationship between blood Cd levels and DFU prevalence.
This study identified a positive correlation between blood cadmium (Cd) levels and the prevalence of DFU. These results suggest that monitoring blood Cd levels in patients with diabetes during follow-up may be important for preventing the development of DFU. However, further prospective studies are necessary to provide additional evidence.
糖尿病足溃疡（DFU）是糖尿病的严重并发症。这些溃疡显著增加了截肢风险。许多研究探讨了血液重金属如何影响糖尿病患者的胰岛素分泌。然而，将血液重金属暴露与DFU联系起来的研究有限。本研究旨在探讨糖尿病患者血液重金属暴露与DFU之间的关联。
这项横断面研究使用了1999 - 2004年国家健康与营养检查调查（NHANES）的数据。研究人员使用电感耦合等离子体质谱法（ICP - MS）测量血液中铅（Pb）和镉（Cd）的水平。四个逻辑回归模型评估了血液重金属与DFU患病率之间的关系。这些模型对潜在的混杂因素进行了调整。此外，进行了平滑曲线拟合和分段回归分析以进一步研究相关性。亚组分析和交互作用检验有助于评估总体人群中的一致性。
最终分析纳入了1664名年龄在40岁及以上的糖尿病患者。平均年龄为64.66±11.79岁，其中男性占52.52%，女性占47.48%。在这些个体中，135人（8.11%）被诊断为DFU。统计模型显示血液镉（Cd）水平与DFU患病率之间存在显著正相关。具体而言，模型4是完全调整后的模型，表明血液Cd水平每增加一个单位，DFU患病率相应增加64% [比值比（OR）= 1.64；95%置信区间（CI）（1.42 - 1.89），p = 0.004]。通过平滑曲线拟合的进一步分析表明血液Cd水平与DFU患病率之间存在显著的线性关系。
本研究确定了血液镉（Cd）水平与DFU患病率之间存在正相关。这些结果表明，在随访期间监测糖尿病患者的血液Cd水平对于预防DFU的发生可能很重要。然而，需要进一步的前瞻性研究来提供更多证据。
