Risk Factors Associated with Diabetic Foot Ulcers: A Multivariate Analysis

Background: Diabetes is a growing global health crisis, with 537 million adults affected in 2021 and an anticipated rise to 643 million by 2030. India faces a particularly high burden, projected to have 125 million cases by 2045. Among its complications, diabetic foot ulcers (DFUs) are the most debilitating, significantly reducing quality of life and straining healthcare systems. This study aims to identify systemic and localized risk factors for DFUs in Indian diabetic patients using a case–control approach. Methods: A case–control study was conducted at a tertiary care hospital, enrolling 70 DFU cases and 140 matched controls. Data were collected through medical records and structured interviews. Univariate and multivariate logistic regression analyses were performed to identify risk factors. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to determine independent predictors. Results: Sensory loss to monofilament (OR: 6.5, CI: 3.4–12.4), sensory loss to vibration (OR: 5.0, CI: 2.6–9.7), and absence of pedal pulse (OR: 5.0, CI: 2.5–9.9) were strongly associated with DFUs in univariate analysis. Significant localized factors included callus formation (OR: 5.6, CI: 2.7–11.7) and foot deformities (OR: 7.0, CI: 2.9–17.0). Elevated glycated hemoglobin (HbA1c) levels (≥6.5%) (OR: 6.4, CI: 3.3–12.4) and insulin therapy (OR: 22.4, CI: 10.4–48.4) were also notable contributors. Multivariate analysis identified HbA1c ≥6.5% (adjusted OR: 2.8), insulin therapy (adjusted OR: 5.5), trauma (adjusted OR: 7.8), callus formation (adjusted OR: 5.9), and foot deformity (adjusted OR: 12.9) as independent predictors. Conclusion: This study highlights a combination of systemic (e.g. poor glycemic control, advanced diabetes) and localized (e.g. trauma, callus, and deformities) risk factors for DFUs. Early identification and multidisciplinary care focusing on glycemic control, podiatric assessments, and patient education are crucial for prevention. These findings can guide targeted interventions to reduce the burden of DFUs.