title: Diabetic Microangiopathy Is an Independent Predictor of Incident Diabetic Foot Ulcer.
abstract: OBJECTIVE
  To determine the diabetic foot ulcer incidence and examine its association with microangiopathy complications, including diabetic retinopathy (DR) and albuminuria (Alb), in type 2 diabetes patients.
  
  
  METHODS
  This was a retrospective cohort study of 1,305 patients with type 2 diabetes who were assigned to the following groups: Category 1, normoalbuminuria without DR (n = 712); Category 2, Alb without DR (n = 195); Category 3, normoalbuminuria with DR (n = 185); and Category 4, Alb with DR (n = 213). Cox proportional hazard models were used to compare the risks of developing diabetic foot ulcers across the categories.
  
  
  RESULTS
  During 14,249 person-years of follow-up, 50 subjects developed diabetic foot ulcers, with incidence rates of 1.6/1,000, 1.5/1,000, 3.4/1,000, and 12.5/1,000 person-years in Categories 1, 2, 3, and 4, respectively. After adjusting for the presence of diabetic neuropathy and macroangiopathy, the hazard ratios and 95% confidence intervals (CIs) for the risk of diabetic foot ulcer development were 0.66 (95% CI, 0.18-2.36), 1.72 (95% CI, 0.67-4.42), and 3.17 (95% CI, 1.52-6.61) in Categories 2, 3, and 4, respectively, compared with Category 1.
  
  
  CONCLUSIONS
  The presence of DR and Alb significantly increases the risk of diabetic foot ulcer development.
authors.affiliation: Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo 108-0073, Japan.
authors.forename: Masuomi
authors.identifier: 0000-0003-3445-7407
authors.initials: M
authors.lastname: Tomita
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, Tokai University Hachioji Hospital, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kabeya
authors.affiliation: Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo 108-0073, Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Okisugi
authors.affiliation: Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo 108-0073, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Katsuki
authors.affiliation: Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo 108-0073, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Oikawa
authors.affiliation: Diabetes Center, Eiju General Hospital, Tokyo, Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Atsumi
authors.affiliation: Saiseikai Shibuya Satellite Clinic, Tokyo, Japan.
authors.forename: Kempei
authors.initials: K
authors.lastname: Matsuoka
authors.affiliation: Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo 108-0073, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Shimada
mesh_terms: D000419:Albuminuria / Q000175:diagnosis / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology*; D017719:Diabetic Foot / Q000175:diagnosis / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors