{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T14:09:52Z","timestamp":1790258992630,"version":"4.1.0"},"reference-count":11,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,3]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>To identify patterns of co-occurring macrovascular complications among people with diabetes-related foot ulceration (DFU) using latent class analysis (LCA) and describe characteristics associated with identified profiles.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Single-centre retrospective clinical audit with secondary observational analysis of routinely collected data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Townsville University Hospital, North Queensland, Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>381 adults with type 1 or type 2 diabetes and at least one documented DFU managed between 2015 and 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>LCA of ischaemic heart disease, stroke, peripheral vascular disease and heart failure. Model selection considered information criteria, class size, classification certainty, stability and clinical interpretability. Secondary analyses compared demographic and clinical characteristics between classes. Mortality was examined descriptively because follow-up duration was inconsistently available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A two-class model had the lowest Akaike information criterion (1464.6), Bayesian information criterion (BIC) (1500.1) and sample-size-adjusted BIC (1471.5), identifying a higher-burden profile (94\/381, 24.7%) and lower-burden profile (287\/381, 75.3%). Conditional probabilities in higher-burden versus lower-burden profiles were 80.7% vs 20.9% for ischaemic heart disease, 29.6% vs 5.1% for stroke, 63.1% vs 25.8% for peripheral vascular disease and 37.5% vs 5.6% for heart failure. Compared with the lower-burden profile, the higher-burden profile had older age (68.83 vs 63.89 years; p=0.001), lower Estimated Glomerular Filtration Rate (eGFR) (51.24 vs 65.77 mL\/min\/1.73 m\u00b2; p&lt;0.001), higher creatinine (156.69 vs 120.39 \u00b5mol\/L; p=0.013), and more hypertension (93.6% vs 78.0%; p=0.002), dyslipidaemia (87.2% vs 70.3%; p=0.002) and chronic kidney disease (54.3% vs 24.4%; p&lt;0.001). Smoking status differed overall (p=0.017), with current smoking more common in the higher-burden profile (38.0% vs 24.3%). Glycated hemoglobin (HbA1c) did not differ (8.30% vs 8.46%; p=0.628). Recorded mortality was higher in the higher-burden profile (29\/78, 37.2% vs 28\/269, 10.4%; p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among people with DFU, LCA identified higher-macrovascular-burden and lower-macrovascular-burden profiles that largely reflected cumulative macrovascular disease rather than distinct biological phenotypes. These exploratory findings require replication in contemporary multicentre cohorts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-119751","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:50:15Z","timestamp":1790257815000},"page":"e119751","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Macrovascular burden profiles in diabetes-related foot ulceration: a latent class analysis of a regional Australian cohort"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3859-3118","authenticated-orcid":false,"given":"Harshal","family":"Deshmukh","sequence":"first","affiliation":[{"name":"Gold Coast Hospital and Health Service, Southport, Queensland, Australia"},{"name":"College of Medicine and Dentistry, James Cook University, Townsville City, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Mathew","sequence":"additional","affiliation":[{"name":"Mackay Base Hospital, Mackay, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajinkya","family":"Bidwe","sequence":"additional","affiliation":[{"name":"College of Medicine and Dentistry, James Cook University, Townsville City, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen Xing","family":"Teh","sequence":"additional","affiliation":[{"name":"Mackay Base Hospital, Mackay, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkat N","family":"Vangaveti","sequence":"additional","affiliation":[{"name":"College of Medicine and Dentistry, James Cook University, Townsville City, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul Aziz","family":"Seidu","sequence":"additional","affiliation":[{"name":"College of Medicine and Dentistry, James Cook University, Townsville City, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasant","family":"Shenoy","sequence":"additional","affiliation":[{"name":"College of Medicine and Dentistry, James Cook University, Townsville City, Queensland, Australia"},{"name":"Townsville University Hospital, Townsville, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thozhukat","family":"Sathyapalan","sequence":"additional","affiliation":[{"name":"Hull York Medical School, University of Hull, Hull, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usman H","family":"Malabu","sequence":"additional","affiliation":[{"name":"College of Medicine and Dentistry, James Cook University, Townsville City, Queensland, Australia"},{"name":"Townsville University Hospital, Townsville, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"2026092406500742000_16.9.e119751.1","doi-asserted-by":"crossref","DOI":"10.1186\/s13047-020-00383-2","article-title":"Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer","volume":"13","author":"Armstrong","year":"2020","journal-title":"J Foot Ankle Res"},{"key":"2026092406500742000_16.9.e119751.2","doi-asserted-by":"publisher","DOI":"10.2337\/dci22-0043"},{"key":"2026092406500742000_16.9.e119751.3","doi-asserted-by":"crossref","DOI":"10.1186\/s13047-021-00447-x","article-title":"Diabetes-related foot disease in Australia: a systematic review of the prevalence and incidence of risk factors, disease and amputation in Australian populations","volume":"14","author":"Zhang","year":"2021","journal-title":"J Foot Ankle 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Med"},{"key":"2026092406500742000_16.9.e119751.7","doi-asserted-by":"crossref","DOI":"10.1186\/s13047-017-0230-5","article-title":"Defining the gap: a systematic review of the difference in rates of diabetes-related foot complications in Aboriginal and Torres Strait Islander Australians and non-Indigenous Australians","volume":"10","author":"West","year":"2017","journal-title":"J Foot Ankle Res"},{"key":"2026092406500742000_16.9.e119751.8","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2025-098999","article-title":"Epidemiology and healthcare access inequities in diabetic foot disease: a retrospective study in Central Queensland, Australia","volume":"15","author":"Soonarane","year":"2025","journal-title":"BMJ Open"},{"key":"2026092406500742000_16.9.e119751.9","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1111\/imj.70222","article-title":"Predictive factors for lower extremity amputations in patients with diabetic foot disease in Central Australia","volume":"55","author":"Ashok","year":"2025","journal-title":"Intern Med J"},{"key":"2026092406500742000_16.9.e119751.10","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1111\/jdi.12952","article-title":"Review of the role of cigarette smoking in diabetic foot","volume":"10","author":"Xia","year":"2019","journal-title":"J Diabetes Investig"},{"key":"2026092406500742000_16.9.e119751.11","doi-asserted-by":"crossref","first-page":"8550","DOI":"10.1038\/s41598-024-59158-5","article-title":"The association between tobacco smoking and systolic toe pressures in active foot ulceration","volume":"14","author":"Bechara","year":"2024","journal-title":"Sci Rep"}],"container-title":["BMJ 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