Only 10% of Chinese adults with diabetes demonstrate good practices for diabetic foot careMost people with diabetes lack good foot care practices

Frontiers in Medicine Published September 7, 2026 DOI ↗ Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

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Key Takeaway

Note that only 10% of patients with diabetes demonstrated good foot-care practices despite 67% reporting favorable attitudes.

This systematic review and meta-analysis evaluates the knowledge, attitudes, and practices (KAP) regarding diabetic foot care among 6,124 Chinese adults with diabetes across 13 provinces. The study provides a descriptive overview of patient behavior and awareness in a specific geographic region.

The meta-analysis found that 43% of patients had satisfactory knowledge, while 26% had good knowledge. In contrast, 33% reported poor knowledge. Regarding attitudes, 67% reported favorable attitudes, while 33% reported unfavorable attitudes. However, practical application was notably lower, with only 10% of patients exhibiting good practices and 45% demonstrating satisfactory practices. The remaining 45% were categorized as having poor practices.

The authors note substantial heterogeneity across most outcomes and highlight that the cross-sectional design limits the results to descriptive data. These findings suggest that while patient attitudes may be generally positive, translating those attitudes into high-quality foot care practices remains a challenge. These results may inform the development of risk-stratified and behavior-oriented strategies for diabetic foot prevention.

How this fits prior evidence

This meta-analysis addresses a gap in understanding the behavioral and educational components of diabetic foot care. While previous evidence indicates that functional creams or urea-containing formulations can reduce xerosis severity in patients with diabetes, this study highlights that only 10% of patients currently demonstrate good foot-care practices. The findings suggest that clinical interventions may need to be paired with targeted education to improve patient practices.

Living with diabetes often means extra vigilance, especially when it comes to foot health. A large study of over 6,000 adults in China looked at how much people actually knew about and practiced proper foot care. The results show a significant gap between what people feel and what they do. While 67% of people had favorable attitudes toward foot care, only 10% were actually performing good practices.

Most people had satisfactory knowledge, but many still struggled with the daily habits needed to keep their feet safe. For example, 33% of people had poor knowledge, and 45% had poor practices. This suggests that having a good attitude is only the first step; consistent, high-quality habits are much harder to maintain.

Because this was a cross-sectional study, it provides a snapshot of current habits rather than showing how behaviors change over time. However, the data highlights that good foot care practices remain uncommon. These findings can help experts create better programs to move people from having a good attitude to practicing safe habits every day.

What this means for you:

Only 10% of people with diabetes practiced good foot care, despite many having positive attitudes toward it.

Common questions

What did the study find about knowledge of foot care?

The study found that 43% of people had satisfactory knowledge about foot care, while 26% had good knowledge. However, 33% of the people surveyed still had poor knowledge regarding how to care for their feet.

How many people actually practiced good foot care?

Only 10% of the people in the study were found to have good foot care practices. While 45% had satisfactory practices, the number of people performing high-quality, consistent care was quite low.

Do people with diabetes have a positive attitude toward foot care?

Yes, the study showed that 67% of the participants had favorable attitudes toward foot care. This suggests that while people want to care for their feet, they may still need more support to turn those feelings into daily actions.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedSep 2026

View Original Abstract ↓

BackgroundDiabetic foot is a serious and largely preventable complication of diabetes. Patient knowledge, attitudes, and practices (KAP) regarding foot care are central to early prevention, yet the overall distribution of KAP levels among patients with diabetes in China remains unclear. This systematic review and meta-analysis aimed to estimate the pooled proportions of different levels of diabetic foot care-related KAP among patients with diabetes in China.MethodsThe review was registered in PROSPERO (CRD420261328954) and followed PRISMA 2020 reporting guidance. PubMed, Embase, Scopus, the Cochrane Library, Web of Science, CINAHL Complete, SinoMed, CNKI, Wanfang, and VIP were searched from inception to March 2, 2026. Cross-sectional studies reporting extractable diabetic foot-care KAP data among Chinese adults with diabetes were included. Study quality was assessed using the 11-item Agency for Healthcare Research and Quality checklist. Random-effects proportion meta-analyses used the Freeman-Tukey double arcsine transformation. Subgroup, sensitivity, and small-study effect analyses were conducted where data allowed.ResultsTwenty-four cross-sectional studies involving 6,124 participants across 13 Chinese provinces or municipalities were included. Fourteen studies contributed to the meta-analysis of knowledge, five to attitudes, and seventeen to practices. The pooled proportions of poor, satisfactory, and good knowledge were 33% (95% CI: 19–48%), 43% (95% CI: 33–54%), and 26% (95% CI: 17–37%), respectively. For attitudes, 33% (95% CI: 10–62%) of participants had unfavorable attitudes and 67% (95% CI: 38–90%) had favorable attitudes. For practices, the pooled proportions of poor, satisfactory, and good foot care practices were 45% (95% CI: 35–55%), 45% (95% CI: 38–53%), and 10% (95% CI: 6–14%), respectively. Substantial heterogeneity was observed across most outcomes, and subgroup analyses did not identify statistically significant differences by study region, diabetic foot status, or publication period.ConclusionChinese patients with diabetes generally showed favorable attitudes toward diabetic foot care, but knowledge remained insufficient and good foot-care practices were uncommon. Because all included studies were cross-sectional, the pooled estimates primarily characterize the distribution of KAP levels and should be interpreted descriptively. When considered alongside existing guidelines and intervention evidence, these findings may inform the development of risk-stratified, behavior-oriented, and system-supported strategies for diabetic foot prevention.Systematic review registrationPublicly accessible record: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261328954. PROSPERO registration: CRD420261328954.

Only 10% of Chinese adults with diabetes demonstrate good practices for diabetic foot careMost people with diabetes lack good foot care practices

How this fits prior evidence

Common questions

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How this fits prior evidence

Common questions

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