Factors Related to Severity of Diabetic Foot Ulcer
A Systematic Review
Keywords:
Diabetes mellitus, foot ulcer, risk, associatedAbstract
Background: Diabetes mellitus (DM) has become a pressing global health concern, with the number of cases escalating significantly over the past few decades. Diabetic foot ulcers (DFUs), among the complications of DM, present a substantial burden, with prevalence rates ranging from 4 to 10% and severe cases associated with heightened mortality rates. This study aims to consolidate research findings on the factors influencing DFU severity to inform preventive strategies and improve patient care. Methods: This systematic review focused on full-text English literature published between 2014 and 2024 using the PRISMA 2020 guidelines. The literature was compiled using PubMed, ScienceDirect, and SagePub, among other online venues. Result: Five publications were found to be directly related to our ongoing systematic examination after a rigorous three-level screening approach. Subsequently, a comprehensive analysis of the complete text was conducted, and additional scrutiny was given to these articles. Conclusion: Diabetic foot ulcer (DFU) is a serious complication of diabetes, influenced by various factors, including lifestyle and self-care practices. Educating patients on proper foot hygiene and care, along with comprehensive training for healthcare providers, can mitigate DFU severity.
References
IDF Diabetes Atlas 9th edition; 2019. Available from: https://diabetesatlas.org/en/. Accessed Dec 13, 2019.
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4–14. doi:10.1016/j.diabres.2009.10.00
Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94(3):311–321. doi:10.1016/j.diabres.2011.10.02
Hamano K, Nakadaira I, Suzuki J, Gonai M. N-terminal fragment of probrain natriuretic peptide is associated with diabetes microvascular complications in type 2 diabetes. Vasc Health Risk Manag. 2014;10:585–589. doi:10.2147/VHRM.S67753
Choudhry Abid Nazir S, Nawaz R. Severity and outcome of patients presenting with diabetic foot at Tertiary Care Center at Gujrat. Pakistan Journal of Medical and Health Sciences. 2019;13(4):1024–1026
Bakker K, Apelqvist J, Lipsky BA, Van Netten JJ. The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: development of an evidence-based global consensus. Diabetes Metab Res Rev. 2016;32(Suppl 1):2–6. doi:10.1002/dmrr.2694
Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217–228. doi:10.1001/jama.293.2.217
Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017;49(2):106–116. doi:10.1080/07853890.2016.1231932
Simbolon, Prabowo W. and Ibrahim, Hilman (2020) "Risk Factors that Influence Hospital Length of Stay in Diabetic Foot Ulcer with Negative Pressure Wound Therapy at RS. dr. Cipto Mangunkusumo," The New Ropanasuri Journal of Surgery: Vol. 5 : No. 1 , Article 6. DOI: 10.7454/nrjs.v5i1.1069 Available at: https://scholarhub.ui.ac.id/nrjs/vol5/iss1/6
Ghobadi A, Sarbarzeh P, Jalilian M, Abdi A, Manouchehri S. Evaluation of factors affecting the severity of diabetic foot ulcer in patients with diabetes referred to a diabetes centre in Kermanshah. Diabetes Metab Syndr Obes. 2020;13:693–703. doi:10.2147/DMSO.S242431
Madmoli M, Madmoli Y, Taqvaeinasab H, Khodadadi M, Darabiyan P, Rafi A. Some influential factors on severity of diabetic foot ulcers and Predisposing of limb amputation: a 7-year study on diabetic patients. Int J Ayurvedic Med. 2019;10(1):75–81.
Smith-StrømH, Iversen MM, Igland J, Østbye T, Graue M, Skeie S, et al. (2017) Severity and duration of diabetic foot ulcer (DFU) before seeking care as predictors of healing time: A retrospective cohort study. PLoS ONE 12(5): e0177176. https://doi.org/10.1371/journal. pone.0177176
Meidani M, Khorvash F, Rajabpournikfam MR. The relationship between controlling HbA1C and infected diabetic foot ulcer. J Isfahan Med Sch. 2012;30. Shahi SK, Kumar A, Kumar S, Singh SK. Prevalence of diabetic foot ulcer and associated risk factors in diabetic patients from North India. J Diabetic Foot Complications. 2012;4(3):83–91.
Mariam TG, Alemayehu A, Tesfaye E, et al. Prevalence of diabetic foot ulcer and associated factors among adult diabetic patients who attend the diabetic follow-up clinic at the University of Gondar Referral Hospital, North West Ethiopia, 2016: institutional-Based Cross-Sectional Study. J Diabetes Res. 2017;2017.
Bakri FG, Allan AH, Khader YS, Younes NA, Ajlouni KM. Prevalence of diabetic foot ulcer and its associated risk factors among diabetic patients in Jordan. Jordan Med J. 2012;171(785):1–1
Taghipour M, Abi Kordadeh E, Eslami M. Review of biomechanical parameters of diabetic foot ulcers. Razi J Med Sci. 2016;23(144):51–67. Ochoa-
Gonzalez F, Cervantes-Villagrana AR, Fernandez-Ruiz JC, et al. Metformin induces cell cycle arrest, reduced proliferation, wound healing impairment in vivo and is associated to clinical outcomes in diabetic foot ulcer patients. PLoS One. 2016;11:3.
Assaad-Khalil S, Zaki A, Rehim AA, et al. Prevalence of diabetic foot disorders and related risk factors among Egyptian subjects with diabetes. Prim Care Diabetes. 2015;9(4):297–303. doi:10.1016/j.pcd.2014.10.010
Brennan MB, Hess TM, Bartle B, et al. Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes. J Diabetes Complications. 2017;31(3):556–561. doi:10.1016/j.jdiacomp.2016.11.020
Rice JB, Desai U, Cummings AK, Birnbaum HG, Skornicki M, Parsons NB. Burden of diabetic foot ulcers for medicare and private insurers. Diabetes Care. 2014;37(3):651–658. doi:10.2337/dc13-2176
Beckert S, Witte M, Wicke C, Königsrainer A, Coerper S. A new wound-based severity score for diabetic foot ulcers. Diabetes Care. 2006;29(5):988. doi:10.2337/dc05-2431 Menezes JVF, Sreenidhi G. Clinical utility of diabetic ulcer severity score in surgical practice. Int J Surg. 2019;6(7):2469–2474. doi:10.18203/2349-2902.isj20192976
Apelqvist J, Agardh CD, Castenfors J, Larsson J, Stenström A. Wound classification is more important than site of ulceration in the outcome of diabetic foot ulcers. Diabetic Med. 1989;6(6):526–530. doi:10.1111/j.1464-5491.1989.tb01221.x
Marzoq A, Shiaa N, Zaboon R, Baghlany Q, Alabbood MH. Assessment of the outcome of diabetic foot ulcers in Basrah, Southern Iraq: a cohort study. Int J Diabetes Metab. 2019;25(1–2):33–38. doi:10.1159/000500911
Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World J Diabetes. 2015;6(1):37. doi:10.4239/wjd.v6.i1.37
Schaper NC, van Netten JJ, Apelqvist J, et al. Practical guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36:e3266. doi:10.1002/dmrr.3266
Zhang -S-S, Tang Z-Y, Fang P, Qian H-J, Xu L, Ning G. Nutritional status deteriorates as the severity of diabetic foot ulcers increases and independently associates with prognosis. Exp Ther Med. 2013;5(1):215–222. doi:10.3892/etm.2012.780
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Niken Pratiwi, Barry Barry (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
