J Korean Acad Nurs.  2021 Jun;51(3):280-293. 10.4040/jkan.20257.

Development of a Diabetic Foot Ulceration Prediction Model and Nomogram

  • 1College of Nursing, Healthcare Sciences & Human Ecology, Dong-Eui University, Busan, Korea
  • 2College of Nursing, Pusan National University, Yangsan, Korea
  • 3Department of Orthopedics, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 4Endovascular and Vascular and Transplantation Division, Department of Surgery, Pusan National University Hospital, Busan, Korea
  • 5Division of Nursing, Severance Hospital, Seoul, Korea
  • 6IT Convergence College of Components and Materials Engineering, Dong-Eui University, Busan, Korea


This study aimed to identify the risk factors for diabetic foot ulceration (DFU) to develop and evaluate the performance of a DFU prediction model and nomogram among people with diabetes mellitus (DM).
This unmatched case-control study was conducted with 379 adult patients (118 patients with DM and 261 controls) from four general hospitals in South Korea. Data were collected through a structured questionnaire, foot examination, and review of patients’ electronic health records. Multiple logistic regression analysis was performed to build the DFU prediction model and nomogram. Further, their performance was analyzed using the Lemeshow–Hosmer test, concordance statistic (C-statistic), and sensitivity/specificity analyses in training and test samples.
The prediction model was based on risk factors including previous foot ulcer or amputation, peripheral vascular disease, peripheral neuropathy, current smoking, and chronic kidney disease. The calibration of the DFU nomogram was appropriate (χ2 = 5.85, p = .321). The C-statistic of the DFU nomogram was .95 (95% confidence interval .93~.97) for both the training and test samples. For clinical usefulness, the sensitivity and specificity obtained were 88.5% and 85.7%, respectively at 110 points in the training sample. The performance of the nomogram was better in male patients or those having DM for more than 10 years.
The nomogram of the DFU prediction model shows good performance, and is thereby recommended for monitoring the risk of DFU and preventing the occurrence of DFU in people with DM.


Diabetic Foot; Foot Ulcer; Logistic Models; Risk
Full Text Links
  • JKAN
export Copy
  • Twitter
  • Facebook
Similar articles
    DB Error: unknown error