Diabetic Foot Ulcers in Pakistan: A Silent Epidemic?-A Meta-Analysis of Observational Studies

Diabetic foot ulcers (DFUs) are a major complication of diabetes, leading to severe morbidity and high healthcare costs. Despite numerous studies on the prevalence of DFUs in Pakistan, the findings vary widely, making it difficult to obtain a clear estimate. To address this gap, we conducted a meta-analysis to determine the overall prevalence of DFUs among diabetic patients in Pakistan, providing a more comprehensive understanding of the burden of this condition.

A systematic search was conducted in PakMediNet, PubMed, Scopus, Web of Science, and Google Scholar without language or time restrictions. Two independent reviewers screened studies, extracted data, and assessed quality. Heterogeneity was evaluated using Cochran's Q and I². Subgroup analysis, meta-regression, and sensitivity analysis were performed. Publication bias was assessed via a funnel plot and Egger's test. The meta-analysis was conducted using a random-effects model in Stata 17.

In this meta-analysis, 16 studies with a total of 15,333 participants were analyzed. The pooled prevalence of DFUs was estimated at 18%, with a prevalence of 19.4% in Punjab and 16.6% in other regions. The prevalence was reported as 20.8% in men and 14.9% in women. Sensitivity analysis indicated that the results were highly stable. Meta-regression revealed a significant increasing trend in the prevalence of DFUs from 1999 to 2022. Although statistical tests confirmed the presence of publication bias, the trim-and-fill method suggested that its impact was negligible.

This meta-analysis provides a comprehensive estimate of the prevalence of DFUs, highlighting regional and gender differences. The findings show a significant increasing trend over time, emphasizing the growing burden of this condition. These results highlight the need for targeted prevention strategies and improved management of DFUs.