Non-Biomedical Factors in Diabetic Foot Prevention in Ulcer-Free Patients: A Delphi Consensus Study

Background/Objectives: Diabetic foot disease is associated with high rates of ulceration, amputation and premature mortality. While biomedical risk factors are systematically assessed in clinical practice, non-biomedical determinants—psychological, behavioural, social and socioeconomic—remain largely absent from existing risk stratification models. This study aimed to achieve expert consensus on the relevance of non-biomedical factors in the prevention of diabetic foot disease in people with diabetes without prior ulceration. Methods: A two-round Delphi consensus study was conducted with a multidisciplinary panel of 21 experts. A 24-item questionnaire, developed through narrative literature review and tested for content validity, was administered. Items were rated on a nine-point Likert scale, with consensus defined a priori as at least 70% of ratings falling within the 7–9 range. The study was prospectively registered on the Open Science Framework. Results: Of the 24 items presented in Round 1, 21 (87.5%) reached consensus. Six items were re-rated in Round 2, of which two crossed the threshold, giving 23 of 24 items (95.8%) endorsed as highly relevant after two rounds. No active disagreement was detected for any item, and all 21 panellists completed both rounds. One item did not reach consensus: shame or stigma associated with diabetes (14/21; 66.7%). Conclusions: Expert consensus supports the relevance of 23 non-biomedical factors in the prevention of diabetic foot disease in ulcer-free patients. These factors constitute a candidate framework for the development of risk screening tools complementing existing biomedical assessment models; their predictive value and clinical utility require prospective validation.