Knowledge, attitudes, and practices related to diabetic foot care among individuals with diabetes in India: a systematic review and meta-analysis

Diabetic foot complications are a significant public health concern in India, leading to increased morbidity, amputations, and healthcare costs. Assessing the knowledge, attitudes, and practices (KAP) of individuals with diabetes toward foot care is essential for designing effective prevention and management strategies. This review aimed to synthesize evidence on diabetic foot care-related KAP among individuals with diabetes in India. A systematic search was conducted across major databases, grey literature sources, and reference lists of identified studies using predefined keywords up to May 16, 2025. Articles were screened on the basis of predefined inclusion criteria, and data from eligible studies were independently extracted. Pooled estimates were derived using a random-effects meta-analysis model, and the risk of bias was assessed using the Newcastle‒Ottawa Scale for cross-sectional studies (NOS-xs2). Twenty studies published between 2012 and 2025, covering 13 Indian states and 2 Union territories, were included. The findings revealed low levels of good knowledge (32%), favourable attitudes (20%), and effective practices (26%) towards foot care. Although substantial heterogeneity was observed, minimal publication bias strengthened confidence in the results. Regional disparities highlighted significant underrepresentation from large parts of the country with diverse cultural and healthcare contexts. The review identified major gaps in diabetic foot care knowledge across India, with nearly two-thirds lacking patient-centred awareness or preventive behaviours. Addressing these challenges requires culturally tailored education and interprofessional strategies to reinforce preventive practices across healthcare. Regionally inclusive research and coordinated national initiatives are crucial to strengthening self-care, reducing complications, and easing the diabetic foot disease burden in India.