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Background <p>Diabetic foot ulcers (DFUs) are a severe complication of type 2 diabetes mellitus (T2DM), linked to high morbidity and mortality. This study explores biomarkers related to DFU risk and progression to improve management strategies. This study was conducted to identify early biomarkers that could predict DFU risk before ulceration occurs.</p> Methods <p>A case-control study was conducted with 33 T2DM patients and 37 non-diabetic controls. Bioimpedance-derived metrics—phase angle (PA), extracellular water-to-total body water ratio (AEC/ACT), and extracellular mass-to-body cell mass ratio (ECMe/BCMe)—were analyzed alongside lipid profiles (total cholesterol, LDL, HDL), the Controlling Nutritional Status (CONUT) index, and the triglyceride-glucose index. DFU risk was classified using International Working Group on Diabetic Foot criteria.</p> Results <p>Low LDL levels (&lt; 50th percentile) correlated with reduced PA in cases (<i>p</i> &lt; 0.001), indicating impaired cellular function and tissue repair. PA negatively correlated with DFU risk (<i>p</i> = 0.005), supporting its utility as a health marker. HDL positively correlated with AEC/ACT in cases (<i>p</i> = 0.004), suggesting its role in fluid regulation. The CONUT index correlated negatively with total cholesterol (<i>p</i> = 0.007) and LDL (<i>p</i> = 0.004), highlighting malnutrition’s impact on lipid imbalances. Hydric indices increased across DFU risk groups, with AEC/ACT significantly higher in Risk Group 1 versus controls (<i>p</i> = 0.048). ECMe/BCMe correlated positively with AEC/ACT in low LDL cases (<i>p</i> = 0.013), reflecting metabolic stress.</p> Conclusions <p>LDL and PA are critical biomarkers for DFU risk and progression, offering insights into cellular integrity, tissue repair, and fluid balance. Integrating these biomarkers into clinical practice could optimize DFU management, reduce complications, and improve patient outcomes.</p>

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Integrative biomarker analysis in diabetic foot: lipids, cellular integrity, and hydration balance

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月18日

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  • Esther Soler-Climent,
  • Jessica Román-Marroquí,
  • Rosa María Cuadrado-Zaplana,
  • Gema Prats-Boluda,
  • Isabel Junquera-Godoy,
  • Gemma Gonzalez-Lorente,
  • C. Martinez-Corbalán

摘要

Background

Diabetic foot ulcers (DFUs) are a severe complication of type 2 diabetes mellitus (T2DM), linked to high morbidity and mortality. This study explores biomarkers related to DFU risk and progression to improve management strategies. This study was conducted to identify early biomarkers that could predict DFU risk before ulceration occurs.

Methods

A case-control study was conducted with 33 T2DM patients and 37 non-diabetic controls. Bioimpedance-derived metrics—phase angle (PA), extracellular water-to-total body water ratio (AEC/ACT), and extracellular mass-to-body cell mass ratio (ECMe/BCMe)—were analyzed alongside lipid profiles (total cholesterol, LDL, HDL), the Controlling Nutritional Status (CONUT) index, and the triglyceride-glucose index. DFU risk was classified using International Working Group on Diabetic Foot criteria.

Results

Low LDL levels (< 50th percentile) correlated with reduced PA in cases (p < 0.001), indicating impaired cellular function and tissue repair. PA negatively correlated with DFU risk (p = 0.005), supporting its utility as a health marker. HDL positively correlated with AEC/ACT in cases (p = 0.004), suggesting its role in fluid regulation. The CONUT index correlated negatively with total cholesterol (p = 0.007) and LDL (p = 0.004), highlighting malnutrition’s impact on lipid imbalances. Hydric indices increased across DFU risk groups, with AEC/ACT significantly higher in Risk Group 1 versus controls (p = 0.048). ECMe/BCMe correlated positively with AEC/ACT in low LDL cases (p = 0.013), reflecting metabolic stress.

Conclusions

LDL and PA are critical biomarkers for DFU risk and progression, offering insights into cellular integrity, tissue repair, and fluid balance. Integrating these biomarkers into clinical practice could optimize DFU management, reduce complications, and improve patient outcomes.