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Review
. 2023 May;20(5):1762-1775.
doi: 10.1111/iwj.14017. Epub 2022 Nov 17.

Influencing factors for the recurrence of diabetic foot ulcers: A meta-analysis

Qingjiao Guo  1 , Gu Ying  2 , Ouyang Jing  2 , Yizhi Zhang  1 , Yang Liu  3 , Meijie Deng  4 , Shirong Long  4
Affiliations
Review

Influencing factors for the recurrence of diabetic foot ulcers: A meta-analysis

Qingjiao Guo et al. Int Wound J. 2023 May.

Abstract

This study aims to systematically review and identify the related influencing factors for the recurrence of diabetic foot ulcers (DFUs)in diabetic patients. We searched PUBMED, EMBASE, Web of Science, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wan Fang and VIP databases to identify eligible studies published before March 31, 2022 to collect case-control studies or cohort studies on the related influencing factors for the recurrence of DFUs. Two reviewers independently screened the literature, and extracted data. Also, they assessed the risk of bias of the included studies using the Newcastle-Ottawa Scale. A meta-analysis was performed using RevMan5.4.1 software. 20 studies were included; 4238 patients were enrolled, in which 1567 were in the DFU recurrence group and 2671 were in the non-recurrent DFU group. Risk factors for the recurrence of DFUs included diabetic peripheral neuropathy (odds ratio [OR] = 4.05, 95% CI, 2.50-6.58, P < 0.00001), peripheral vascular disease (OR = 3.94, 95% CI, 2.65-5.84, P < 0.00001), poor blood glucose control (OR = 3.27, 95% confidence interval [CI], 2.79-3.84, P < 0.00001), plantar ulcer (OR = 3.66, 95% CI, 2.06-6.50, P < 0.00001), osteomyelitis (OR = 7.17, 95% CI, 2.29-22.47, P = 0.0007), smoking (OR = 1.98, 95% CI, 1.65-2.38, P < 0.00001), history of amputation (OR = 11.96, 95%CI, 4.60-31.14, P < 00001), multidrug-resistant bacterial infection (OR = 3.61, 95%CI, 3.13-4.17, P < 0.00001), callus (OR = 5.70, 95%CI, 1.36-23.89, P = 0.02), previous diabetic foot ulcer (OR = 4.10, 95% CI, 2.58-6.50, P < 0.00001), duration of previous diabetic foot ulcer >60d (OR = 1.02, 95% CI, 1.00-1.03, P = 0.004), history of vascular intervention (OR = 3.20, 95% CI, 2.13-4.81, P < 0.00001) and Wagner grade III/IV (OR = 4.40, 95% CI, 2.21-8.78, P < 0.0001). However, no significant differences were found in age, duration of diabetes, body mass index, total cholesterol or foot deformity. Recurrence of diabetic foot ulcers is affected by a variety of factors. Thus, we should focus on high-risk groups and take targeted interventions as soon as possible to reduce the recurrence rate of DFUs, because of the limited quality and quantity of the included studies, more rigorous studies with adequate sample sizes are needed to verify the conclusion.

Keywords: diabetic foot ulcer; meta-analysis; recurrence; risk factor.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of the literature search
FIGURE 2
FIGURE 2
Forest plot: effect of age on diabetic foot ulcer recurrence
FIGURE 3
FIGURE 3
Forest plot: effect of smoking on diabetic foot ulcer recurrence
FIGURE 4
FIGURE 4
Forest plot: effect of BMI on diabetic foot ulcer recurrence
FIGURE 5
FIGURE 5
Forest plot effect of duration of diabetes on diabetic foot ulcer recurrence
FIGURE 6
FIGURE 6
Forest plot effect of poor blood glucose control on diabetic foot ulcer recurrence
FIGURE 7
FIGURE 7
Forest plot effect of plantar ulcer on diabetic foot ulcer recurrence
FIGURE 8
FIGURE 8
Forest plot effect of DPN on diabetic foot ulcer recurrence
FIGURE 9
FIGURE 9
Forest plot effect of Osteomyelitis on diabetic foot ulcer recurrence
FIGURE 10
FIGURE 10
Forest plot: effect of PAD on diabetic foot ulcer recurrence
FIGURE 11
FIGURE 11
Forest plot: effect of the duration of DFUs >60d on DFU recurrence
FIGURE 12
FIGURE 12
Forest plot: effect of TC on diabetic foot ulcer recurrence
FIGURE 13
FIGURE 13
Forest plot effect of amputation on diabetic foot ulcer recurrence
FIGURE 14
FIGURE 14
Forest plot effect of multidrug‐resistant bacterial infection on diabetic foot ulcer recurrence
FIGURE 15
FIGURE 15
Forest plot effect of Wagner grade (III/IV) on diabetic foot ulcer recurrence
FIGURE 16
FIGURE 16
Forest plot effect of history of vascular intervention on diabetic foot ulcer recurrence
FIGURE 17
FIGURE 17
Forest plot effect of foot deformity on diabetic foot ulcer recurrence
FIGURE 18
FIGURE 18
Forest plot effect of callus on diabetic foot ulcer recurrence
FIGURE 19
FIGURE 19
Forest plot effect of previous DFUs on diabetic foot ulcer recurrence
See this image and copyright information in PMC

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