{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T12:51:28Z","timestamp":1781787088075,"version":"3.54.5"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100017686","name":"Fujian Provincial Health Technology Project","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100017686","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study aimed to develop a simplified cross-sectional pre-screening tool for diabetic foot ulcer (DFU) using routinely available clinical indicators, with particular focus on the albumin-to-glycated hemoglobin ratio (Alb\/HbA1c) as a composite marker of nutritional status and glycemic control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 1,854 hospitalized patients with type 2 diabetes (training set, January 2012\u2013December 2020) and 678 outpatients (validation set, January 2021\u2013December 2025) from a geographically distinct branch of the same hospital system. Demographic characteristics, lifestyle factors, and laboratory parameters were collected. LASSO regression and multivariate logistic regression were used for predictor selection. Model performance was assessed by area under the curve (AUC), calibration curves, Hosmer\u2013Lemeshow test, and Brier score. Risk was visualized using nomograms and heatmaps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>DFU prevalence was 20.9% in the training set and 15.8% in the validation set. Four independent predictors were identified: age (OR\u00a0=\u00a01.029\/year), history of injury (OR\u00a0=\u00a07.57), alcohol consumption (OR\u00a0=\u00a00.48, see Discussion for interpretation), and Alb\/HbA1c ratio (OR\u00a0=\u00a00.49). The model showed good discrimination in the training (AUC 0.807, 95% CI 0.790\u20130.825) and validation sets (AUC 0.817, 95% CI 0.782\u20130.852), with acceptable calibration (Hosmer-Lemeshow P &amp;gt; 0.05; Brier scores 0.127 and 0.118). Internal validation confirmed stability (optimism-corrected AUC\u00a0=\u00a00.803). Risk heatmaps revealed synergistic interactions between age and Alb\/HbA1c, with injury history amplifying risk across all strata.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This simplified pre-screening model using age, injury history, alcohol consumption, and Alb\/HbA1c demonstrates a high negative predictive value, making it suitable for ruling out DFU in resource-limited primary care settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1847695","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T04:56:25Z","timestamp":1780030585000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of a simplified pre-screening model for diabetic foot ulcer identification in diabetic patients"],"prefix":"10.3389","volume":"17","author":[{"given":"Weidi","family":"Wang","sequence":"first","affiliation":[{"name":"Trauma Center and Emergency Surgery Department, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Guo","sequence":"additional","affiliation":[{"name":"Trauma Center and Emergency Surgery Department, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sining","family":"Chen","sequence":"additional","affiliation":[{"name":"Trauma Center and Emergency Surgery Department, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenshi","family":"Ou","sequence":"additional","affiliation":[{"name":"Hepatopancreatobiliary Surgery Department, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoyi","family":"Wu","sequence":"additional","affiliation":[{"name":"Trauma Center and Emergency Surgery Department, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,29]]},"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","DOI":"10.1016\/s2213-8587(16)00051-6","article-title":"Diabetic foot care in China: challenges and strategy","volume":"4","author":"Xu","year":"2016","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B3","article-title":"Safety and effectiveness of biphasic insulin aspart 30 in both Chinese young and elderly patients with type 2 diabetes: results from the A1chieve study","volume":"6","author":"Li","year":"2014","journal-title":"Chin J Diabetes Mellitus"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3657","article-title":"Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update)","volume":"40","author":"Schaper","year":"2024","journal-title":"Diabetes Metab Res Rev"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2319","article-title":"Predictive factors for diabetic foot ulceration: a systematic review","volume":"28","author":"Monteiro-Soares","year":"2012","journal-title":"Diabetes Metab Res Rev"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.2337\/dc06-1661","article-title":"Prediction of diabetic foot ulcer occurrence using commonly available clinical information: the Seattle Diabetic Foot Study","volume":"29","author":"Boyko","year":"2006","journal-title":"Diabetes Care"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.13559","article-title":"Microneedling in the treatment of atrophic scars: a systematic review of randomised controlled trials","volume":"18","author":"Sachdeva","year":"2021","journal-title":"Int Wound J"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-78828-y","article-title":"Assessing the diagnostic utility of urinary albumin-to-creatinine ratio as a potential biomarker for diabetic peripheral neuropathy in type 2 diabetes mellitus patients","volume":"14","author":"Zhang","year":"2024","journal-title":"Sci Rep"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-S002","article-title":"2. 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