Predictive factors for diabetic foot ulcers

Predictive factors for diabetic foot … [Diabetes Metab Res Rev. 2012] 

The more things change…the more they stay the same. Previous DFU or amputation– aka diabetic foot remission…remains the strongest predictor of future events.

bleeding under callus preulcerative.jpg
Late-stage preulcerative callus



Endocrinology, Diabetes and Metabolism Department – Diabetic Foot team, Centro Hospitalar de Vila Nova de Gaia/ Espinho EPE; Department of Health Information and Decision Sciences (CIDES), Center for Research in Health Technologies and Information Systems (CINTESIS), Oporto Faculty of Medicine, Portugal.



Improving ability to predict and prevent diabetic foot ulcer (DFU) is imperative due to the high personal and financial costs of this complication. We therefore conducted a systematic review in order to identify all studies of factors associated with DFU and assess whether available DFU risk stratification systems incorporate those factors of highest potential value.


We performed a search in PubMed for studies published until April 2011 that analysed the association between independent variables and DFU. Articles were selected by 2 investigators independent and blind to each other. Divergence was solved by a third investigator.


A total of 71 studies were included and evaluated the association between DFU and more than 100 independent variables. The variables most frequently assessed were age, gender, diabetes duration, body mass index, HbA1C and neuropathy diagnostic tests. DFU prevalence varied greatly among studies. The majority of the identified variables were assessed by only 2 or fewer studies. Diabeticneuropathy, peripheral vascular disease, foot deformity and previous DFU or lower extremity amputation – which are the most common variables included in risk stratification systems – were consistently associated with DFU development.


Existing DFU risk stratification systems often include variables shown repeatedly in the literature to be strongly predictive of this outcome. Improvement of these risk classification systems though is impaired due to deficiencies noted including a great lack of standardization in outcome definition and variable selection and measurement. Copyright © 2012 John Wiley & Sons, Ltd.
Copyright © 2012 John Wiley & Sons, Ltd.

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