Introduction and Objective: To develop approaches to prevent amputation and to better understand the interplay between DN and DFU, we compared cardiometabolic risk factors between Veterans with DN alone and Veterans with healed DFU. We evaluated both routinely targeted risk factors—ABCs [A1c, blood pressure (BP), cholesterol], smoking, obesity, and eGFR—as well as non-targeted risk factors such as CRP, fibrinogen, and body fat percentage.Methods: Baseline data from two RCTs were analyzed, one a DFU secondary prevention RCT and the other a DFU primary prevention RCT in participants with DN. Unadjusted comparisons used Fisher’s exact test for categorical variables and Wilcoxon Rank-Sum tests for continuous variables. Age-adjusted logistic and linear regression analyses compared the groups for dichotomous and continuous outcomes, with results reported as estimates or ORs (with 95% CIs).Results: Data were from 241 Veterans with prior DFU and 406 with DN alone. There were no differences by group in age, sex, race/ethnicity or education. Unadjusted DFU vs. DN comparisons found: current smokers (23.7% vs. 17.2%, p = 0.034), body fat % (26.9 vs. 29.3, p < 0.001), CRP ≥ 2 mg/L (3.3% vs. 2.5%, p < 0.001) and eGFR (70.0 vs. 79.0, p < 0.001). Age-adjusted DFU vs. DN comparisons found: OR for elevated body fat % 0.62 (CI 0.43, 0.89; p = 0.01); linear regression estimates: body fat % -2.30 (-3.68, -0.91; p = 0.001); BMI -0.97 (-1.91, -0.03; p = 0.04); eGFR -7.35 (-11.58, -3.11; p = 0.001) and fibrinogen 15.79 (-1.52, 33.11; p = 0.07). For A1c, BP, and LDL-C comparisons, all p-values > 0.1.Conclusion: Both DN and DFU groups were similar in ABCs, a success. The DFU group had lower BMI, body fat % and eGFR, as well as higher CRP and borderline fibrinogen, all likely reflecting more advanced diabetes. More importantly, smoking was high in both DN and DFU (DFU > DN) despite long-standing public health focus and serious risks; novel ways to reduce smoking must be urgently developed.
S. Thakkar: None. T. Chen: None. D. Ingerman: None. A. Nicholson: None. N. Illenberger: None. S. Natarajan: None.
VA Rehabilitation, Research and Development Service, Office of Research and Development (E1858-R); Health Services Research and Development Service, VA Office of Research and Development (IIR 14-009)
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