{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:04:50Z","timestamp":1786122290161,"version":"build-2736575974"},"reference-count":51,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001349","name":"National Medical Research Council","doi-asserted-by":"publisher","award":["MOH\u2010CSAINV24jul\u20100005"],"award-info":[{"award-number":["MOH\u2010CSAINV24jul\u20100005"]}],"id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001349","name":"National Medical Research Council","doi-asserted-by":"publisher","award":["CSIRG24jul\u20100010"],"award-info":[{"award-number":["CSIRG24jul\u20100010"]}],"id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To evaluate the association between diabetic corneal neuropathy and diabetic foot risk by examining corneal nerve features, clinical characteristics, and tear mediators in patients with different diabetic foot risk categories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cross\u2010sectional study, 710 participants underwent diabetic foot examination, in\u00a0vivo confocal microscopy scans, ocular surface assessments, and tear mediators measurements. Ordinal regression analysis was applied to determine the associations between foot risk categories and corneal nerve metrics. ROC curve analysis assessed the ability of corneal nerve parameters to identify high\u2010risk diabetic foot.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All diabetic foot risk categories exhibited significantly impaired corneal nerve fibre length, density, fractal dimension, and more swollen width compared with controls (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). These patients also demonstrated significantly shorter tear break\u2010up time, more severe ocular symptoms, elevated tear MMP\u20109, and reduced tear Substance P levels (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Patients with high\u2010risk diabetic foot showed significantly more pronounced corneal nerve alterations than those in low and moderate\u2010risk groups (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). The more severe diabetic foot risk category was significantly associated with reduced nerve fibre length, density, fractal dimension, and increased width (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). A predictive model incorporating corneal nerve fibre length, width, and serum creatinine achieved an AUC of 0.80 for identifying high\u2010risk diabetic foot. A CNFL &lt;\u20095.7\u2009mm\/mm\n                      <jats:sup>2<\/jats:sup>\n                      was associated with 4.37\u2010fold higher odds of having a high\u2010risk diabetic foot.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Corneal nerve impairment is evident even in low\u2010risk diabetic foot patients and is associated with foot risk severity. Corneal nerve metrics may serve as early indicators for identifying high\u2010risk diabetic foot.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.71021","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T02:41:03Z","timestamp":1781836863000},"page":"8219-8229","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diabetic Corneal Neuropathy as a Window Into Diabetic Foot Risk: A Large\u2010Scale Association Study"],"prefix":"10.1111","volume":"28","author":[{"given":"Chang","family":"Liu","sequence":"first","affiliation":[{"name":"Regenerative Therapy Group Singapore Eye Research Institute  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingyi","family":"Yu","sequence":"additional","affiliation":[{"name":"Regenerative Therapy Group Singapore Eye Research Institute  Singapore 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