Meta-analysis reports diabetes-related foot disease incidence from two large cohortsDiabetes foot disease rates vary wildly between UK and China populations

We aimed to estimate the incidence for overall and individual components of diabetes-related foot disease (DFD), and explore potential heterogeneity across studies. We included patients with diabetes who were free of DFD from UK Biobank and Chongqing Diabetes Registry (CDR). We defined DFD according to the International Working Group on the Diabetic Foot 2023 criteria. We further performed meta-analyses by integrating results from the two cohorts and 64 cohorts identified from a systematic review of literature, and quantifying the extent of variation in reported incidence rates. The incidence of DFD was 12.81 (95 % confidence interval[CI]: 12.46-13.15) and 24.97 (21.38-28.99) per 1,000 person-year in UK Biobank and CDR, respectively. The pooled estimates were 19.84 (95 %CI: 16.58-23.10) for peripheral neuropathy, 7.32 (6.17-8.47) for foot ulcer, 2.56 (2.20-2.93) for lower-extremity amputation, 2.56 (1.08-4.04) for lower-extremity arterial disease, and 0.81 (0.00-1.74) for gangrene, respectively. Heterogeneity was high across studies (I > 99 %). In conclusion, incidence for DFD exceeds 10 per 1,000 person-year among patients with diabetes, and peripheral neuropathy and foot ulcer are major contributors to incident DFD. These estimates should be interpreted as descriptive summaries of available evidence rather than a single universal incidence, and large heterogeneity underscores the context-specific nature of DFD occurrence.