Published: 2020-06-25

Prospective observational study evaluating association of sociodemographic parameters, Wagner’s grading, peripheral arterial disease and diabetic peripheral neuropathy with the outcomes of diabetic foot ulcers

Vishnu S. Ravidas, Samadarsi P., Ajayan G.


Background: The present study was conducted to determine the association of sociodemographic parameters, comorbid conditions and complications of diabetes mellitus (DM) with the treatment outcomes of diabetic foot ulcers.

Methods: The present prospective observational study enrolled 105 participants aged 30-85 years with diabetic foot ulcers presenting to general surgery department during a period of 18 months. Participants who were terminally ill, who had trophic ulcers of Hansen’s disease and filariasis and its sequelae were excluded. The study was approved by institutional ethics committee and written informed consent was obtained from all study participants. Data was analyzed using R and the test of significance was chi square test, p<0.05 was considered statistically significant.

Results: Higher proportion of male participants and those aged between 50-69 years were encountered. Male participants were of higher age and the mean duration of DM in participants with diabetic foot ulcer was 8 years. The mean HbA1C of study participants was 8.1%, 38.1% participants had high plasma glucose. Food deformity was observed in 41% participants. 62.9% and 66.7% participants had diabetic peripheral neuropathy and peripheral arterial disease respectively. The mean time required for healing among participants with diabetic foot ulcers was 45.8 Significant association of major amputation with diabetic peripheral neuropathy (p=0.02), Wagner’s grading (p<0.001) and peripheral arterial disease (PAD) (p=0.006) was observed.

Conclusions: The presence of diabetic peripheral neuropathy and PAD were risk factors for major amputations in diabetic foot ulcers. Lower Wagner’s grading was associated with lower chances of major amputation.


Diabetic foot ulcers, Peripheral neuropathy, Wagner’s grading, Peripheral arterial disease

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Goyal R, Jialal I. Diabetes Mellitus Type 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2020 Mar 11]. Available from:

Diabetes [Internet]. [cited 2020 Mar 13]. Available from:

Kannan R. India is home to 77 million diabetics, second highest in the world. The Hindu [Internet]. 2019 Nov 14 [cited 2020 Mar 13]; Available from:

Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017 15;376(24):2367–75.

Oliver TI, Mutluoglu M. Diabetic Foot Ulcer. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2020 Mar 11]. Available from:

Singer AJ, Tassiopoulos A, Kirsner RS. Evaluation and Management of Lower-Extremity Ulcers. N Engl J Med. 2018 18;378(3):302–3.

Alexiadou K, Doupis J. Management of Diabetic Foot Ulcers. Diabetes Ther [Internet]. 2012 Dec [cited 2020 Mar 12];3(1). Available from:

Wang CL, Wang M, Liu TK. Predictors for wound healing in ischemic lower limb amputation. J Formos Med Assoc Taiwan Yi Zhi. 1994 Oct;93(10):849–54.

Saap LJ, Falanga V. Debridement performance index and its correlation with complete closure of diabetic foot ulcers. Wound Repair Regen Off Publ Wound Heal Soc Eur Tissue Repair Soc. 2002 Dec;10(6):354–9.

Kautzky-Willer A, Harreiter J, Pacini G. Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. Endocr Rev. 2016 Jun;37(3):278–316.

Navarro-Peternella FM, Lopes APAT, de Arruda GO, Teston EF, Marcon SS. Differences between genders in relation to factors associated with risk of diabetic foot in elderly persons: A cross-sectional trial. J Clin Transl Endocrinol. 2016 Oct 13;6:30–6.

Kwon KT, Armstrong DG. Microbiology and Antimicrobial Therapy for Diabetic Foot Infections. Infect Chemother. 2018 Mar;50(1):11–20.

Hajar R. Diabetes as “Coronary Artery Disease Risk Equivalent”: A Historical Perspective. Heart Views Off J Gulf Heart Assoc. 2017;18(1):34–7.

Alex R, Ratnaraj B, Winston B, Samson Devakiruba DN, Samuel C, John J, et al. Risk Factors for Foot Ulcers in Patients with Diabetes Mellitus - A Short Report from Vellore, South India. Indian J Community Med Off Publ Indian Assoc Prev Soc Med. 2010 Jan;35(1):183–5.