Factors influencing the severity of diabetic foot ulcers: a cross-sectional study

Diabetic foot ulcers (DFUs) are prevalent among individuals with poorly controlled diabetes, and severe cases can result in increased morbidity and a poor quality of life. This study aimed to identify the factors that affect the severity of DFUs, offering insights into potential interventions that could enhance patient outcomes.

A prospective cross-sectional study was conducted from August 2023 to March 2024 at Muhimbili National Hospital in Tanzania, involving 177 consecutively selected patients with DFUs. The primary outcome variable was the severity of DFUs, which was assessed using the Meggitt-Wagner severity score. Both socio-demographic and clinical characteristics were evaluated to determine their association with the outcome variable using multivariate ordinal logistic regression analysis.

The median age of the study participants was 60 years (IQR = 52-68), with a male-to-female ratio of 2 to 1. Notably, Wagner grades 4 and 5 accounted for 57.6% of the participants. Factors associated with increased severity of DFUs included age over 60 years (aOR = 1.83, 95% CI 1.05-3.23, p = 0.035) and poor adherence to diabetes medications (aOR = 2.62, 95% CI 1.36-5.09, p = 0.004). Conversely, having health insurance coverage was linked to better outcomes (aOR = 0.51, 95% CI 0.27-0.96, p = 0.036).

The study highlights factors that can enhance comprehensive care for diabetic patients, especially elderly individuals. Key measures include implementing educational programs to encourage medication adherence, improving healthcare access, particularly for uninsured individuals, promoting insurance coverage, and making diabetes treatments more affordable.