After signing an informed consent, participants will be interviewed using a standard questionnaire to obtain information on demographic characteristics (including sex, date of birth, race, education, occupation, annual income, residence, family history and diabetic duration), lifestyle risk factors (physical activity, smoking status and alcohol consumption), history of past and present illness, and current medications. Blood pressure, height, weight and waist circumference will be measured with the use of standard methods. Fasting blood samples and urine sample will be collected to test blood routine, liver and renal function, eGFR, glucose, lipid, serum creatase, glycated hemoglobin (HbA1c), urine routine, and urinary albumin to creatinine ratio. Ankle brachial index (ABI) will also be measured using a pulse waveform analyzer BP-203RPE II (form PWV/ABI, Omron Healthcare Co., Kyoto, Japan).

Based on the above-mentioned information, eligible participants will be defined by an on-site investigator and then randomized to the study group or control group by an independent offsite investigator. Subsequently, every randomized participant will continue to perform plantar pressure tests by the trained podiatrist. Footscan® Pressure Measurement System (RSscan international NV, Paal, Blegium) will be used to obtain the data of plantar pressure. Before plantar pressures are measured, each participant will undertake at least two practice walks along the plate walkway to familiarize them with the experimental process. Then, each participant will be asked to walk in bare feet upon the footscan platform at self-selected gait speed for at least three successful trials. The foot data including peak plantar pressure will be recorded by the Footscan® pressure measure system, which automatically divided the foot into 10 masked regions: hallux, toes 2–5, first to fifth metatarsals, midfoot, medial heel, and lateral heel. Locations of previous ulceration, foot deformity or preulcerative signs will be the primary sites of interest. In additional, blood flow parameters of lower extremities, which include maximum systolic velocity, maximum diastolic velocity, and time-averaged mean velocity, will also be assessed by a vascular ultrasound specialist in the vascular ultrasound room of our hospital that is a quiet temperature-controlled environment. Measures will be performed at the same time of day for individual subjects.

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