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Meta-Analysis
. 2023 Nov 28;18(11):e0284054.
doi: 10.1371/journal.pone.0284054. eCollection 2023.

Prevalence of diabetic foot at risk of ulcer development and its components stratification according to the international working group on the diabetic foot (IWGDF): A systematic review with metanalysis

Tania Maldonado-Valer  1 , Luis F Pareja-Mujica  1 , Rodrigo Corcuera-Ciudad  2 , Fernando Andres Terry-Escalante  3   4 , Mylenka Jennifer Chevarría-Arriaga  3 , Tery Vasquez-Hassinger  1 , Marlon Yovera-Aldana  5
Affiliations
Meta-Analysis

Prevalence of diabetic foot at risk of ulcer development and its components stratification according to the international working group on the diabetic foot (IWGDF): A systematic review with metanalysis

Tania Maldonado-Valer et al. PLoS One. .

Abstract

Aims: To determine the overall prevalence of diabetic foot at risk according to the International Working Group on the Diabetic Foot stratification.

Materials and methods: We searched PubMed/Medline, Scopus, Web of Science, and Embase. We included cross-sectional studies or cohorts from 1999 to March 2022. We performed a meta-analysis of proportions using a random-effects model. We assessed heterogeneity through subgroup analysis by continent and other characteristics.

Results: We included 36 studies with a total population of 11,850 people from 23 countries. The estimated overall prevalence of diabetic foot at risk was 53.2% (95% CI: 45.1-61.3), I2 = 98.7%, p < 0.001. In the analysis by subgroups, South and Central America had the highest prevalence and Africa the lowest. The factors explaining the heterogeneity were the presence of chronic kidney disease, diagnostic method for peripheral arterial disease, and quality. The estimates presented very low certainty of evidence.

Conclusions: The overall prevalence of diabetic foot at risk is high. The high heterogeneity between continents can be explained by methodological aspects and the type of population. However, using the same classification is necessary for standardization of the way of measuring the components, as well as better designed general population-based studies.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart for the selection of included studies.
From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. The PRISMA Statement and the PRISMA Explanation and Elaboration document are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. (http://prisma-statement.org/PRISMAStatement/CitingAndUsingPRISMA.aspx.
Fig 2
Fig 2. Prevalence of foot at risk according to IWGDF stratification: characteristics and geographical location by continents of the included studies.
“Continental organizations” by Sbb1413 is licenced under CC-BY 4.0 /Modified from original.
Fig 3
Fig 3. Forest Plot (random effects model) of the diabetic foot at risk of ulceration metanalysis according to IWGDF stratification.
Fig 4
Fig 4. Cumulative metanalysis of the diabetic foot at ulceration risk according to IWGDF stratification.
Fig 5
Fig 5. Sensitivity metanalysis by the consecutive exclusion of the 36 included studies.
Fig 6
Fig 6
A. Diabetic foot at risk of ulceration according to IWGDF stratification of the 36 included studies Funnel Plot. A—Classic Funnel Plot. B. Diabetic foot at risk of ulceration according to IWGDF stratification of the 36 included studies Funnel Plot. B–Funnel Plot trimmed studies.
See this image and copyright information in PMC

References

    1. Boulton AJM, Vileikyte L, Ragnarson-tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366: 1719–1724. doi: 10.1016/S0140-6736(05)67698-2 - DOI - PubMed
    1. Armstrong DG, Swerdlow MA, Armstrong AA, Conte MS, Padula W V, Bus SA. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res. 2020;13: 16. doi: 10.1186/s13047-020-00383-2 - DOI - PMC - PubMed
    1. Monteiro-Soares M, Boyko EJ, Ribeiro J, Ribeiro I D-RM. Predictive factors for diabetic foot ulceration: a systematic review. Diabetes Metab Res Rev. 2012;28: 574–600. doi: 10.1002/dmrr.2319 - DOI - PubMed
    1. Schaper NC, van Netten JJ, Apelqvist J, Bus SA, Hinchlife RJ, Lipsky BA et al. IWGDF Guidelines on the Prevention and Management of Diabetic Foot Disease. Wound Pract Res. 2019. doi: 10.33235/wpr.27.3.144 - DOI - PubMed
    1. Morgado A, Couceiro R, Ribeiro R, Dias V, Moreira M, Mourão P. Diabetic foot ulcer development risk classifications’ validation: A multicentre prospective cohort study. Diabetes Res Clin Pract. 2017;127: 105–14. doi: 10.1016/j.diabres.2017.02.034 - DOI - PubMed