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

OBJECTIVE: This cross-sectional study was designed to explore the independent link between the HbA1c/high-density lipoprotein cholesterol ratio (HHR) and diabetic foot ulcer (DFU) among adult Han patients from northwest China. METHODS: Clinical data from 866 patients with type 2 diabetes mellitus (T2DM) were retrospectively analyzed in Honghui Hospital of Xi'an Jiaotong University between July 2023 and March 2026. Logistic regression models were applied to estimate the association between HHR and DFU risk, with smooth curve fitting (SCF) used to characterize potential nonlinear trends. Discriminatory capacity of HHR for DFU detection was assessed using receiver operating characteristic (ROC) curve, and quantified the area under the curve (AUC). In addition, decision curve analysis (DCA) was conducted to evaluate the clinical net benefit of HHR. RESULTS: After adjusting for all covariates, the logistic regression demonstrated that every one-unit elevation in HHR was correlated with a remarkable increase in DFU risk, corresponding to an OR of 1.327 (95% CI: 1.222-1.440). Compared to the lowest tertile, the highest tertile of HHR was linked to a substantially elevated DFU risk, with an OR of 5.366 (95% CI: 2.939-9.798). The SCF also exhibited similar trends. Moreover, compared with the triglyceride-glucose (TyG) index (AUC = 0.649, 95% CI: 0.609-0.690), the HHR yielded a significantly larger area under the ROC curve of 0.704 (95% CI: 0.663-0.745) for DFU identification. Furthermore, the results of DCA demonstrated that HHR conferred a higher net clinical benefit across a wide range of threshold probabilities for DFU identification. CONCLUSION: This study demonstrated a positive correlation between DFU and the combined glucose-lipid metabolic dysfunction status represented by increased HHR in northwest Chinese Han adults with T2DM, and offer supportive evidence for the promising role of HHR as an auxiliary metabolic marker for the evaluation of DFU. Accordingly, closer DFU assessment and foot examination may be essential for T2DM individuals with elevated HHR. However, additional large-sample prospective investigations are still required to validate the putative causal associations suggested by the present observational data.