Regional differences in risk factors and clinical presentation of diabetic foot lesions

Diabet Med. 2004 Jan;21(1):91-5. doi: 10.1046/j.1464-5491.2003.01069.x.


Background: Problems associated with the diabetic foot are worldwide. However, there may be regional variation among risk factors and clinical presentation. Prospective comparative data concerning this topic are rare.

Aim: To determine differences in underlying risk factors and clinical presentation of foot problems among people with diabetes in different regions.

Patients and methods: Six hundred and thirteen consecutive patients with diabetic foot lesions from three centres [Soest-Germany (GER), Dar-es-Salaam, Tanzania (TAN) and Chennai, India (IND)] were included during the period June 1998 through December 1999. Diabetes-related data, risk-factor profiles, and lesion-related data were collected for each patient. Due to varying proportions of recurrent lesions among the centres, only data from patients with newly presenting diabetic foot lesion were analysed.

Results: Of the 613 patients sampled, 368 (60%) were treated for newly presenting diabetic foot lesion. In all three centres, patients were predominately male and had Type 2 diabetes. The average diabetes duration until the onset of the initial foot lesion was 14 years in GER and 12 years in IND, but only 5 years in TAN. The corresponding patient ages were 71, 56 and 51 years. Neuropathy was common to patients in all three centres. Peripheral vascular disease (PVD) was a frequent risk factor in GER (48%). In TAN and IND it was far less common (12 and 13%), probably due to younger patient populations, shorter diabetes duration and lower proportions of smokers. Inadequate footwear was the most common cause of foot lesions in GER (19%), while lack of footwear, irregular foot care and burns were the primary precipitating factors among patients in TAN and IND.

Conclusion: Similarities in different regions of the world among people with diabetes suffering newly presenting foot lesions include a predominance of males and patients with Type 2 diabetes, as well as a high frequency of diabetic neuropathy. However, differences concerning age, diabetes duration, peripheral vascular disease, and precipitating factors contributing to injury are also observed.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetic Foot / epidemiology
  • Diabetic Foot / etiology*
  • Diabetic Neuropathies / complications
  • Diabetic Neuropathies / epidemiology
  • Female
  • Gangrene / epidemiology
  • Gangrene / etiology
  • Germany / epidemiology
  • Humans
  • India / epidemiology
  • Male
  • Middle Aged
  • Peripheral Vascular Diseases / complications
  • Peripheral Vascular Diseases / epidemiology
  • Risk Factors
  • Sex Distribution
  • Shoes
  • Smoking / adverse effects
  • Tanzania / epidemiology
  • Time Factors