{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:31:38Z","timestamp":1793316698829,"version":"4.5.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To identify the risk factors of diabetic foot ulcer (DFU) in patients with type 2 diabetes mellitus (T2DM) and to develop and validate a nomogram prediction model for DFU occurrence in primary care setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a single-center retrospective study enrolling 547 T2DM patients hospitalized at The First People\u2019s Hospital of Lianyungang from January 2019 to April 2022. Patients were randomly divided (3:1) into modeling (n = 411) and validation (n = 136) cohorts, and further stratified by DFU status. Thirty-four clinical variables were extracted for analysis. LASSO regression with tenfold cross-validation identified key features, followed by multivariate logistic regression to determine independent DFU risk factors. A nomogram model was developed using R software, and its performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, the Hosmer\u2013Lemeshow goodness-of-fit test, and decision curve analysis (DCA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 547 T2DM patients, 150 (27.4%) developed DFU. Multivariate analysis identified seven independent risk factors: age (odds ratio [OR] = 1.032, 95% confidence interval [CI]: 1.005\u20131.062, <jats:italic>P<\/jats:italic> = 0.021), white blood cell (WBC) (OR = 1.127, 95% CI: 1.006\u20131.270, <jats:italic>P<\/jats:italic> = 0.043), ankle-brachial index (ABI) (OR = 5.447, 95% CI: 2.186\u201314.340, <jats:italic>P<\/jats:italic> &amp;lt; 0.001), urine albumin-to-creatinine ratio (UACR) (OR = 2.049, 95% CI: 1.062\u20133.936, <jats:italic>P<\/jats:italic> = 0.031), family history of diabetes (OR = 3.405, 95% CI: 1.666\u20137.039, <jats:italic>P<\/jats:italic> &amp;lt; 0.001), diabetic peripheral neuropathy (DPN) (OR = 5.084, 95% CI: 2.673\u20139.805, <jats:italic>P<\/jats:italic> &amp;lt; 0.001), and albumin (ALB) (OR = 0.850, 95% CI: 0.786\u20130.915, <jats:italic>P<\/jats:italic> &amp;lt; 0.001). The developed nomogram demonstrated excellent discrimination (AUC = 0.917 and 0.956 for modeling and validation cohorts). Internal validation confirmed good model reliability (C-index = 0.917). Calibration curves showed strong agreement between predicted and observed outcomes (Hosmer\u2013Lemeshow <jats:italic>P<\/jats:italic> = 0.649 and 0.345). DCA indicated a consistently higher net benefit across threshold probabilities of 0 to 0.8, underscoring the model\u2019s potential clinical utility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The nomogram prediction model developed in this study demonstrates excellent performance and strong clinical applicability. It provides an effective tool to identify high-risk T2DM patients for DFU and guide early preventive interventions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1555163","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T04:10:26Z","timestamp":1751256626000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Development and validation of a nomogram for predicting diabetic foot ulcer risk in patients with type 2 diabetes mellitus"],"prefix":"10.3389","volume":"16","author":[{"given":"Xiuli","family":"Feng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renhao","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teng","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guofeng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic foot ulcers and their recurrence","volume":"376","author":"Armstrong","year":"2017","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s13047-021-00503-6","article-title":"Australian Diabetes-related Foot Disease Guidelines & Pathways Project. 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