Clinical and Behavioral Determinants of Active Diabetic Foot Ulcers: A Cross-Sectional Analysis from Diwaniyah, Iraq
DOI:
https://doi.org/10.66344/jpad.v36i3.3510Keywords:
Diabetic Foot, Peripheral Neuropathies, Glycated Hemoglobin AAbstract
Background Diabetic foot ulceration (DFU) is a severe, costly complication of diabetes mellitus carrying high morbidity and amputation risks. Identifying local predictors is vital for prevention.
Objective To estimate active DFU point prevalence and identify independent clinical and behavioral predictors among diabetic patients in Diwaniyah, Iraq.
Methods A hospital-based cross-sectional study screened 883 diabetic patients to estimate point prevalence. An analytical sample of 170 participants (46 cases, 124 controls) was enrolled using purposive sampling. Factors were analyzed using bivariate tests and multivariable logistic regression.
Results Active DFU point prevalence was 6.57% (58/883). Bivariate analysis showed significant associations with male sex (P=0.003), age >60 years (P<0.001), neuropathy, previous DFU, deformity, fungal infection, and amputation (all P<0.001). Multivariable regression identified four independent predictors: previous DFU (AOR=19.41, 95% CI: 6.02-62.53, P<0.001), neuropathy (AOR=18.12, 95% CI: 3.53-93.07, P=0.001), HbA1c (AOR=1.63, 95% CI: 1.04-2.56, P=0.035), and self-care practices which had a strong protective effect (AOR=0.54, 95% CI: 0.41-0.72, P<0.001).
Conclusion Neuropathy, prior DFU, poor self-care, and high HbA1c independently predict active DFU. Routine clinical screening with 10-g monofilaments and structured foot self-care education in simple local language are recommended to prevent amputations.
References
1. International Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels: International Diabetes Federation; 2021.
2. Armstrong DG, Tan TW, Boulton AJM, Bus SA. Diabetic foot ulcers: A review. JAMA. 2023;330(1):62-74. doi: 10.1001/jama.2023.10578.
3. Edmonds M, Manu C, Vas PRJ. The current burden of diabetic foot disease. J Clin Orthop Trauma. 2021;17:88-93. doi: 10.1016/j.jcot.2021.01.017.
4. Wang X, Yuan CX, Xu B, Yu Z. Diabetic foot ulcers: Classification, risk factors and management. World J Diabetes. 2022;13(12):1049-65. doi: 10.4239/wjd.v13.i12.1049.
5. Mansour AA. Chronic complications of diabetes in Iraq: Experience from Southern Iraq. Clin Med Endocrinol Diabetes. 2009;2:67-73. doi: 10.4137/CMED.S3657.
6. Mohammed AG, Kadhim Al-Waeli D, Abed Odhaib S, Altemimi MT. Assessing the features of diabetic foot ulcers among individuals with diabetes in Basra, Iraq. F1000Res. 2024;13:150995. doi: 10.12688/f1000research.150995.3.
7. Fan Z, Liu Y, Yang Q, Zhang G, Zhang P. Global and regional epidemiology of diabetic foot ulcers and amputations: A systematic review and meta-analysis. BMC Public Health. 2025;25:21639. doi: 10.1186/s12889-025-21639-1.
8. Ntuli ST. Diabetic foot ulcer epidemiology and associated risk factors: A cross-sectional study. Int J Environ Res Public Health. 2025;22(12):1794. doi: 10.3390/ijerph22121794.
9. Tang WH, Zhao YN, Cheng ZX, Xu JX, Zhang Y, Liu XM. Risk factors for diabetic foot ulcers: A systematic review and meta-analysis. Vascular. 2023;32(3):661-9.
doi: 10.1177/17085381231154805.
10. Bereda G. Diabetic foot ulcer: Pathogenesis, diagnosis, and management. Curr Res Diabetes Obes J. 2022;15(3):555920. doi: 10.19080/crdoj.2022.15.555920.
11. Hamzah EF. Risk factors and outcomes of diabetic foot ulcers in a tertiary hospital. South Asian Res J Med Sci. 2025;7(6):3. doi: 10.36346/sarjms.2025.v07i06.003.
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Copyright (c) 2026 Muhammed Fattah Salih, Ali Neamah Hasan Alaaragi
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