Home›Diabetes & Endocrinology› Global meta-analysis establishes pooled incidence and prevalence rates for diabetic foot complications
Global meta-analysis establishes pooled incidence and prevalence rates for diabetic foot complicationsGlobal Data Reveal Common Rates of Diabetic Foot Complications
Diabetes/metabolism research and reviewsPublished September 1, 2026Study authors: Carollo Massimo, Ingrasciotta Ylenia, Crisafulli Salvatore, Maccarrone Francesco, Pellegrino Daniela…PubMed ↗DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Note the global incidence and prevalence rates for diabetic foot complications to inform epidemiological research.
This meta-analysis synthesizes data from 89 studies involving a wide range of participants to establish global epidemiological estimates for diabetic foot complications. The scope includes the incidence and prevalence of ulcerations, amputations, and infections in adults with diabetes mellitus. The analysis identifies significant geographic and demographic variations in these outcomes.
Key findings include an ulceration incidence of 10.93 cases/1000 person-years (95% CI, 6.67-17.91) and an amputation incidence of 3.58 cases/1000 person-years (95% CI, 1.93-6.63). The incidence of infections was 19.11 cases/1000 person-years (95% CI, 4.81-75.97). Prevalence data shows 54.57 cases/1000 persons for active ulcerations, 72.63 cases/1000 persons for past ulcerations, 14.75 cases/1000 persons for amputations, and 39.17 cases/1000 persons for infections.
The authors note high heterogeneity (I > 90%) and heterogeneous methodologies in the primary studies as significant limitations. These findings provide a baseline for future clinical and pharmacoepidemiological studies, though the high heterogeneity suggests caution when applying these specific rates to individual patient management.
How this fits prior evidence
This meta-analysis provides global epidemiological data that complements existing evidence regarding risk factors in diabetic foot patients. It provides a baseline for the prevalence of complications, such as amputations, which were previously linked to sarcopenia. It also provides a broad epidemiological context for infections, which are associated with higher UACR and Gram-negative dominance.
A large review of 89 different studies looked at the frequency of diabetic foot complications. The study included a massive range of participants from across the globe, including Europe, Asia, Africa, America, and Oceania. This data helps experts understand how often these issues occur in the global population.
The findings show specific rates for different complications. For example, the study found an incidence of 10.93 cases of ulcerations and 3.58 cases of amputations for every 1,000 person-years. Infections were reported at a rate of 19.11 cases per 1,000 person-years. The data also showed that many people with diabetes have experienced past ulcerations or infections.
Because the original studies used many different methods, the results have a high level of variation. While the data provides a helpful overview of global trends, it is a broad look at numbers rather than a guide for individual treatment. Patients should talk to their healthcare team to manage their specific risks.
What this means for you:
Global data show common rates of infections, ulcers, and amputations in people with diabetes.
Common questions
How common are infections in people with diabetes?
The study found an incidence of 19.11 cases of infections for every 1,000 person-years. This data comes from a large collection of 89 different studies conducted across several continents.
What are the rates of foot ulcers and amputations?
The data shows an incidence of 10.93 cases of ulcerations and 3.58 cases of amputations for every 1,000 person-years. These figures help researchers understand the global scale of these complications.
Are these rates the same everywhere in the world?
No, the rates vary by region. The study noted that rates in America and Africa were generally above the global average, while rates in Europe, Asia, and Oceania were below the global average.
INTRODUCTION: Diabetic foot (DF) disease, including ulcerations, amputations, and infections, represents a major cause of morbidity and mortality in individuals with diabetes mellitus (DM). Despite their substantial clinical, social, and economic burden, robust global epidemiological estimates remain limited due to fragmented evidence and heterogeneous methodologies. This systematic review and meta-analysis aimed to provide reliable pooled estimates of incidence and prevalence of DF disease, to explore geographic and demographic variations, and to assess the types of data sources available for epidemiological research.
METHODS: Following PRISMA guidelines (PROSPERO registration CRD42025640944), PubMed, Embase, CINAHL Plus, and Cochrane Library were systematically searched from inception to December 21, 2024, for observational studies in adults (≥ 18 years) with DM reporting epidemiological measures of DF disease. Data extraction and quality appraisal (Joanna Briggs Institute checklists) were independently performed by four reviewers. Random-effects meta-analyses were conducted using generalised linear mixed-effects models to calculate pooled complication-specific prevalence and incidence rates among patients with diabetes. Heterogeneity among study estimates was assessed using Cochran's Q test, I statistic, and the between-study variance (τ). To identify sources of heterogeneity, meta-regression analyses were performed considering study-level covariates (modifiers).
RESULTS: Eighty-nine studies were included (18 prospective cohorts, 33 retrospective cohorts, 38 cross-sectional), enrolling between 92 and 29,650,811 participants, with data from Europe (N = 29, 32.6%), Asia (N = 25, 28.1%), Africa (N = 16, 18.0%), America (N = 16, 18.0%), and Oceania (N = 3, 3.4%). Pooled global incidence rates were 10.93 cases/1000 person-years (95% CI, 6.67-17.91) for ulcerations, 3.58 (95% CI, 1.93-6.63) for amputations, and 19.11 (95% CI, 4.81-75.97) for infections. Pooled prevalence estimates were 54.57 cases/1000 persons (95% CI, 37.63-78.52) for active ulcerations, 72.63 (95% CI, 48.21-108.02) for past ulcerations, 14.75 (95% CI, 9.52-22.77) for amputations, and 39.17 (95% CI, 6.81-195.07) for infections. Substantial heterogeneity (I > 90%) was observed, with significant modifiers including geographical region, diabetic foot identification method, data source, study setting, age, diabetes duration, and length of follow-up. Rates in America and Africa were generally above the global pooled average, whereas those in Europe, Asia, and Oceania were below.
CONCLUSIONS: Globally, DF disease is common and severe, with incidence and prevalence rates underscoring its important public health impact. Heterogeneity across studies highlighted the influence of geography, methodology, and data sources. These findings may support future clinical and pharmacoepidemiological studies that evaluate new interventions and monitor temporal trends using large-scale data.
