BMJ Open. 2026 Sep 24;16(9):e119751. doi: 10.1136/bmjopen-2026-119751.
ABSTRACT
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.
DESIGN: Single-centre retrospective clinical audit with secondary observational analysis of routinely collected data.
SETTING: Townsville University Hospital, North Queensland, Australia.
PARTICIPANTS: 381 adults with type 1 or type 2 diabetes and at least one documented DFU managed between 2015 and 2020.
PRIMARY AND SECONDARY OUTCOME MEASURES: 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.
RESULTS: 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 m²; p<0.001), higher creatinine (156.69 vs 120.39 µmol/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<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<0.001).
CONCLUSIONS: 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.
PMID:42785941 | DOI:10.1136/bmjopen-2026-119751