Innovative screening for lower extremity atherosclerotic disease in people with diabetes: using novel and...

Objective. Diabetes mellitus presents a significant global health burden, with patients demonstrating high prevalence of lower extremity atherosclerotic disease (LEAD) and poor prognosis. Despite the crucial need for early screening, primary healthcare lacks accessible LEAD screening protocols for people with diabetes. This study proposed a photoplethysmography (PPG)-based approach to enhance detection sensitivity for this high-risk population.Approach. This study collected toe PPG signals from 104 participants with diabetes, including 54 participants with LEAD. PPG signals underwent preprocessing followed by extraction of 162 features from 7 dimensions. Through a hybrid feature selection framework integrating feature extraction rate filtering and embedded random forest (RF) algorithms, 6 key PPG features were identified for RF classification model construction. The model was evaluated using metrics including sensitivity, specificity, accuracy,F1 score and Kappa coefficient, with DUS results serving as the reference standard.Results.The model achieved 85% sensitivity and 79% specificity, with 82% accuracy andF1-score, indicating good overall performance. The model's Kappa coefficient was 0.63, indicating good agreement with the DUS.Significance. This work demonstrates the feasibility of PPG-based method for screening LEAD in people with diabetes.