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Association between HbA1c/HDL-C ratio and diabetic foot ulcer: a cross-sectional study based on the Han population in

Jie Wang1,2, Qiong Wang1,2, Jianbo Sun1,2

  • 1Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.

Frontiers in Nutrition
|August 13, 2026
PubMed

Insights

The HbA1c/high-density lipoprotein cholesterol ratio (HHR) is linked to a higher risk of diabetic foot ulcers (DFU) in type 2 diabetes patients. Elevated HHR may serve as an important marker for DFU risk assessment.

Area of Science:

  • Endocrinology and Metabolism
  • Cardiovascular Health
  • Diabetology

Background:

  • Diabetic foot ulcer (DFU) is a significant complication of type 2 diabetes mellitus (T2DM).
  • The HbA1c/high-density lipoprotein cholesterol ratio (HHR) combines glycemic control and lipid metabolism, potentially reflecting metabolic dysfunction.
  • Understanding novel biomarkers for DFU risk is crucial for early intervention.

Purpose of the Study:

  • To investigate the independent association between the HHR and the prevalence of DFU in adult Han patients with T2DM from northwest China.
  • To evaluate the diagnostic performance of HHR for DFU compared to the triglyceride-glucose (TyG) index.
  • To assess the clinical utility of HHR in identifying patients at risk for DFU.

Main Methods:

  • Retrospective analysis of clinical data from 866 T2DM patients.
  • Logistic regression models to assess the association between HHR and DFU risk.
  • Smooth curve fitting (SCF), receiver operating characteristic (ROC) curve analysis, and decision curve analysis (DCA) were employed.

Main Results:

  • A one-unit increase in HHR was significantly associated with increased DFU risk (OR = 1.327).
  • The highest tertile of HHR showed substantially elevated DFU risk (OR = 5.366) compared to the lowest tertile.
  • HHR demonstrated superior discriminatory capacity for DFU identification (AUC = 0.704) compared to the TyG index (AUC = 0.649) and offered higher clinical net benefit.

Conclusions:

  • Elevated HHR is positively correlated with DFU in T2DM patients, indicating combined glucose-lipid metabolic dysfunction.
  • HHR shows promise as an auxiliary metabolic marker for evaluating DFU risk.
  • T2DM individuals with elevated HHR require closer DFU assessment and foot examinations; further prospective studies are warranted.
Abstract

Keywords:
HbA1c/HDL-C ratiobiomarkercomplicationdiabetic foot ulcersnutrient metabolism

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