A systematic review and meta-analysis on prevalence and risk factors for diabetic foot ulcers in Nepal

This study aimed to estimate the pooled prevalence of diabetic foot ulcers (DFUs) among Nepalese diabetic population and assess geographical variations and to identify the associated risk factors.

We included hospital- and community-based studies reporting DFU prevalence among people with diabetes in Nepal, published up to 1 August 2025. Case reports, case series, letters, conference abstracts, and studies lacking sufficient data or full texts were excluded. A systematic search was conducted across PubMed, Embase, Cochrane Library, and Google Scholar. Risk of bias was assessed, and publication bias was evaluated using funnel plots and Egger's test. Data were synthesized using a random-effects model with 95% confidence interval (CI) in R software. Subgroup analyses by province and qualitative assessments of risk factors were performed.

Nine studies comprising 18 812 participants with diabetes were included, of whom 722 had DFUs. The pooled prevalence of DFUs was 6.17% (95% CI: 2.56-14.15). Subgroup analysis showed prevalence ranging from 2.9% in Sudurpaschim to 16.8% in Lumbini, indicating geographical variation across Nepal. Smoking (P = 0.004) and age ≥50 years (P = 0.046) were significantly associated with DFUs.

Considerable heterogeneity was noted due to variations in study design, population, and diagnostic criteria. The findings revealed a substantial burden of DFUs in Nepal, highlighting the need for improved foot-care practices, regular screening, and patient education.