Global recurrence rates in diabetic foot ulcers: A systematic review and meta‐analysis

Abstract

Recurrence rates of diabetic foot ulcers vary widely in the published literature. The aim of this systematic review is to estimate recurrence rates of diabetic foot ulcers. We did a PubMed search and performed a review of reference lists for studies reporting recurrence of diabetic foot ulcers. The weighted relative risk (RR) and corresponding 95% confidence interval (CI) for recurrence was estimated. Forty‐nine studies reporting recurrence of diabetic foot ulcers were included. A pooled estimate for recurrence rate was 22.1% per person‐year (py) (95% CI, 19.0‐25.2%). Recurrence rate was 24.9% per py in Europe (95% CI, 20.0%‐29.7%), 17.8% per py in North America (95% CI, 12.7%‐22.9%), 16.9% per py in Africa (95% CI, 4.7%‐29.0%), and 17.0% per py in Asia (95% CI, 11.1%‐23.0%). Turkey had the highest recurrence rate of 44.4% per py (95% CI, 24.9%‐63.9%), and Bangladesh had the lowest of 4.3% per py (95% CI, 2.3%‐6.3%). Recurrence rates of diabetic foot ulcers before 2002, between 2002 and 2008, and after 2008 were 22.2% per py (95% CI, 17.6%‐26.8%), 21.9% per py (95% CI, 17.0%‐26.8%), and 21.8% per py (95% CI, 16.3%‐27.2%), respectively. Recurrence rates of diabetic foot ulcers are high. Recurrence rates vary widely in different regions and have decreased recently. More attention towards recurrence of diabetic foot ulcers is urgently required.

Cumulative long-term recurrence of diabetic foot ulcers in two cohorts from centres in Germany and the Czech Republic

“…Looking only at studies from which raw data are available, the non-recurrence probability at one year is 0.74 and 0.70, translating to 26% and 30% recurrence (personal communication S. Bus and B. Petersen) [3,24]. Moreover, two recent studies which enrolled their patients immediately upon healing their index ulcer, report one year incidences almost identical to ours [25,26]. The effect described above attenuates when comparing the 5-year incidence in our study with the available literature [1,8,10].…”

Microangiopathy: Is it relevant to wound healing in diabetic foot disease?

“…However, this measurement is affected by the presence of both macrovascular and microvascular disease and neuropathy. It can be used to predict wound healing and amputation but there is no standardization of the technique, there is high variation in the repeatability of the measurement within and between individuals, it is less reliable in the presence of oedema and results vary from laboratory to laboratory …”

The role of foot pressure measurement in the prediction and prevention of diabetic foot ulceration—A comprehensive review

“…Diabetic foot ulcers are a costly public health concern, with a large proportion leading to amputation or infection; DFUs are also associated with a reduced quality of life . The lifetime risk of developing a DFU is 15‐25% . However, once ulcerated, DFU recurrence rates are 40% within the first year and up to 65% after 5 years post‐healing .…”