Authors
Touria Ahaouari, Brenda Berendsen, Chantal M Hulshof, Nicolaas C Schaper, Hans Savelberg, Sicco A Bus, Jaap J van Netten
Published in
Diabetes research and clinical practice. Pages 113633. Nov 01, 2026. Epub Nov 01, 2026.
Abstract
We investigated whether decision tree (DT) models and predictor selection strategies can improve stratification of individuals with diabetes at high risk of plantar foot ulcer recurrence.
In a 12-month prospective cohort of 58 participants (mean age 65 years, 83% men) at high risk of diabetes-related plantar ulcer recurrence, three DT models were developed: a predefined model with predictors linked to cumulative plantar tissue stress, and two data-driven models with predictors selected using univariate or elastic net-regularized logistic regression. Performance evaluation included sensitivity, specificity, accuracy and area under the receiver operating characteristic curve (AUC).
Twenty-two participants (38%) developed a recurrent plantar ulcer. The predefined model showed low sensitivity (57%) and specificity (64%). The univariate selection model showed higher performance estimates (sensitivity 71% and specificity 82%). This DT was based on social and physical functioning (36-Item Short Form Health Survey) and self-selected walking speed, with lower social and physical functioning scores indicating higher risk of recurrence.
In this exploratory study, data-driven DT models identified quality-of-life domains as candidate predictors of plantar ulcer recurrence. If validated in larger cohorts, quality-of-life assessments could represent a low-cost addition to current risk stratification in diabetes-related foot ulcer prevention.
PMID:
42967510
Bibliographic data and abstract were imported from PubMed on 02 Nov 2026.
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