Factors Affecting Diabetic Foot Ulcer Among Patients Presenting to Wound Care Clinics Across the Maldives

Diabetic Foot Ulcer (DFU), with an estimated lifetime risk of 25% in diabetic patients, is one of the most disastrous complications of diabetes due to its protracted course of illness and susceptibility to infections. This study aims to assess the factors associated with DFU among adult patients attending to Wound Care Clinics across the Maldives. This hospital-based, case-control study included 61 patients with DFU presented to five government hospitals across the Maldives between April 2023 and April 2024. The control group comprised of 61 diabetic patients without DFU, matched to cases by age group and sex in a 1:1 ratio. Patient demographics and data on all variables considered in the study were collected directly from patients and their hospital clinical records. Chi-square tests were used to assess the association between the variables and DFU. Significant variables were further analyzed using Logistic Regression Models in IBM® SPSS® version 23. The results show that there was an increased likelihood of DFU in patients with an HbA1c level more than 7.5% [OR=2.42, p=0.019, 95% CI: 1.159 – 5.036], on insulin therapy [OR=4.65, p<0.001, 95% CI: 2.101 – 10.288], on Oral Hypoglycemic Agent (OHA) & insulin combination therapy [OR=4.33, p=0.001, 95% CI: 1.860 – 10.068], medication non-compliance [OR=13.2, p<0.001, 95% CI: 4.929– 35.351], Loss of Protective Sensation (LOPS) [OR=27.1, p<0.001, 95% CI: 6.197 – 366.358], Diabetic Neuropathy [OR=27.1, p=0.002, 95% CI: 3.497 – 210.670], and chronic kidney disease [OR=3.0, p=0.019, 95% CI: 1.194 – 7.520]. The risk factors associated with DFU include HbA1c > 7.5%, insulin therapy, insulin and OHA combination therapy, non-compliance to diabetic medications, LOPS, diabetic neuropathy, and CKD. Highest risk of DFU is associated with loss of protective sensation, diabetic neuropathy, and Non-compliance to diabetic medications. Therefore, early interventions to achieve optimal glycemic control and routine screening for diabetic complications must be prioritized to reduce the risk of DFU. Additionally, strategies to improve medication compliance should be integrated into clinical care settings.