Impact of remnant cholesterol and triglycerides on diabetes foot and disease in type 1 diabetes: A propensity score-matched case-control study

Remnant cholesterol is an emerging cardiovascular risk factor; however, its impact on diabetes foot disease (DFD) remains poorly studied. This study evaluates the association between dyslipidaemia and DFD in a cohort of individuals with type 1 diabetes (T1D). A nested case-control study was conducted within a cohort of 419 individuals with T1D. DFD was defined as a history of peripheral arterial disease-such as prior lower limb revascularization or vascular-origin amputations-or as the presence of diabetic foot according to the Wagner classification. Clinical and sociodemographic data were collected, and a 1:2 propensity score matching was performed based on age, sex, diabetes duration, smoking status, HbA1c, diabetic retinopathy, and nephropathy. Conditional logistic regression models were used to evaluate the association between dyslipidemia and DFD, adjusting for confounding variables. Of the 419 subjects, 56 (13.4 %) had DFD. After matching, 17 subjects were excluded, leaving 39 cases and 78 controls (n = 117). The mean age was 61.6 ± 14.3 years, 40.2 % were women, and the mean diabetes duration was 30.0 ± 14.4 years. Remnant cholesterol was significantly higher in cases (22 ± 10 mg/dL vs. 17 ± 11 mg/dL, p = 0.038), as were triglycerides (111 ± 49 mg/dL vs. 90 ± 65 mg/dL, p = 0.005). In multivariable analysis, remnant cholesterol (OR = 1.15, 95 % CI [1.03-1.27]) and triglycerides (OR = 1.03, 95 % CI [1.01-1.05]) were independently associated with DFD. Remnant cholesterol and triglycerides are associated with DFD in individuals with long-standing T1D and high cardiovascular risk. Prospective studies are needed to confirm these findings.