Work

Acute-to-chronic glycemic ratio: a promising biomarker for prognosis of diabetic foot ulcers in a multi-center cohort study

Year: 2026

Type: article

Abstract: The relationship between the acute-to-chronic glycemic ratio (ACG ratio) and diabetic foot ulcers (DFU) has not been established. This study sought to examine its association with the prognosis of DFU. A total of 708 inpatients with DFU were retrospectively enrolled in a multicenter cohort study conducted in China from January 2016 to December 2023. We systematically reviewed demographic, clinical, laboratory, and glucose-related data for patients hospitalized due to diabetic foot complications. For all patients, the ACG ratio was computed using the formula: ACG ratio = Admission Blood Glucose (mg/dL) / [(28.7 × HbA1c)– 46.7], where the denominator estimates the average chronic glucose level. Patients were stratified into tertiles according to their ACG ratio values, with the lowest tertile serving as the reference group. Mortality rates were subsequently compared after an eight-year follow-up period. The acute glucose levels at admission were stratified into tertiles: the first tertile exhibited a median glucose level of 133.2 mg/dL (interquartile range[IQR] 106.2–181.8 mg/dL), the second tertile had a median of 199.8 mg/dL (IQR 156.6–241.2 mg/dL), and the third tertile presented with a median of 315.0 mg/dL (IQR 250.2–410.6 mg/dL), with significant differences observed among these groups. The incidence of sepsis and sepsis-induced multiple organ dysfunction syndrome (MODS) was highest in the third tertile. Within this group of patients with MODS, major adverse cardiovascular events (MACE) were predominantly observed, with 19.23% experiencing MACE, a rate significantly higher than those in the second and first tertiles, which were 5.12% and 11.59%, respectively (P < 0.001). Mortality rates were also elevated in the third tertile compared to the second and first tertiles, with rates of 40.87%, 25.26%, and 22.22%, respectively (P < 0.001). A Cox regression model for mortality revealed an unadjusted hazard ratio of 0.978 (95% CI: 0.676–1.414, P = 0.906) for the second versus first tertile, and 1.679 (95% CI: 1.172–2.405, P = 0.005) for the third versus first tertile. After further adjustment for peripheral arterial disease, cardiovascular diseases, diabetic kidney disease, Wagner grades, and duration of diabetes, the adjusted hazard ratio for the third versus the first ACG ratio tertile was 1.536 (95% CI: 1.067–2.211, P = 0.021). No significant difference in the mortality hazard ratio was observed between the second and first ACG ratio tertiles. Individuals in the third tertile exhibited a greater susceptibility to the development of MODS and acute cardiac injury, accompanied by an elevated mortality rate. The ACG ratio may serve as a potential risk factor for mortality in patients with DFU, particularly among those presenting with severe DFU.

Source: Diabetology & Metabolic Syndrome

DOI: 10.1186/s13098-026-02108-0