The Prognosis of Diabetic Foot Ulcer is Independent of age? A Comparative Analysis of the Characteristics of Patients with Diabetic Foot Ulcer in Different age Groups: A Cross-Sectional Study from China
Restricted accessResearch articleFirst published online December, 2025
The Prognosis of Diabetic Foot Ulcer is Independent of age? A Comparative Analysis of the Characteristics of Patients with Diabetic Foot Ulcer in Different age Groups: A Cross-Sectional Study from China
Background: With younger onset age of type 2 diabetes mellitus (T2DM), the incidence of diabetic foot ulcer (DFU) in young and middle-aged adults is also increasing. Elucidating the distinctive characteristics of DFU in different ages and exploring the influence of age on the prognosis of DFU are crucial to the improvement of DFU treatments. Methods: 684 patients hospitalized for DFU in the department of endocrinology were recruited and assigned into the young and middle-aged group (age <65 years old) and the elderly group (age ≥65 years old). Demographic data and clinical features were compared between two groups. Results: Compared with the elderly group, the young and middle-aged group had higher proportion of males (72.3% vs 49.6%, P < .01) and smokers (52.5% vs 35.8%, P < .01), shorter duration of diabetes mellitus (155 months vs 196 months, P < .01), higher levels of glycosylated hemoglobin (9.3% vs 8.7%, P < .01), lower ratio of ankle-brachial index <0.9 (25.8% vs 51.1%, P < .01) and higher levels of c-reactive protein and erythrocyte sedimentation rate (14 mg/L vs 10 mg/L, P < .05; 36 mm/h vs 30 mm/h, P < .05). The prevalence of diabetic peripheral neuropathy and Wagner Grade were similar in two groups. Of note, the prognosis was similar in different age groups, as there were no significant differences in the healing rate (59.7% vs 60.1%, P > .05), healing time (30 days vs 22 days, P > .05) and minor amputation rate (11.9% vs 8.7%, P > .05). Conclusions: We found that no evidence to suggest a better prognosis with younger DFU patients. Compared with elderly ones, young and middle-aged patients were characterized by a higher proportion of smoking, worse glycemic control, higher inflammatory biomarkers but less severe lower limb ischemia, indicating that smoking cessation, strict blood glucose control and early detection of infection were crucial for improving the prognosis of young and middle-aged diabetic DFU patients.
AbdissaDAdugnaTGeremaUDerejeD. Prevalence of diabetic foot ulcer and associated factors among adult diabetic patients on follow-up clinic at Jimma Medical Center, Southwest Ethiopia, 2019: An institutional-based cross-sectional study. J Diabetes Res.2020;2020:4106383.
2.
HelmerDTsengCLWrobelJ, et al. Assessing the risk of lower extremity amputations using an administrative data-based foot risk index in elderly patients with diabetes. J Diabetes.2011;3(3):248‐255.
3.
LinCWArmstrongDGLinCH, et al. Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period. BMJ Open Diabetes Res Care.2019;7(1):e000795.
4.
HurlowJJHumphreysGJBowlingFLMcBainAJ. Diabetic foot infection: A critical complication. Int Wound J.2018;15(5):814‐821.
5.
WagnerFWJr.The dysvascular foot: A system for diagnosis and treatment. Foot Ankle.1981;2(2):64‐122.
6.
TesfayeSBoultonAJDyckPJ, et al. Diabetic neuropathies: Update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33(10):2285‐2293.
7.
Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified airlie house classification. ETDRS report number 10. Early treatment diabetic retinopathy study research group. Ophthalmology. 1991;98(5 Suppl):786‐806.
8.
MaYCZuoLChenJH, et al. Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J Am Soc Nephrol.2006;17(10):2937‐2944.
9.
BenotmaneAMohammediFAyadFKadiKAzzouzA. Diabetic foot lesions: Etiologic and prognostic factors. Diabetes Metab.2000;26(2):113‐117.
10.
BouterKPStormAJde GrootRRUitslagerRErkelensDWDieperslootRJ. The diabetic foot in Dutch hospitals: Epidemiological features and clinical outcome. Eur J Med.1993;2(4):215‐218.
11.
AbbottCACarringtonALAsheH, et al. The north-west diabetes foot care study: Incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med. 2002;19(5):377‐384.
12.
PemayunTGDNaibahoRM. Clinical profile and outcome of diabetic foot ulcer, a view from tertiary care hospital in Semarang, Indonesia. Diabet Foot Ankle.2017;8(1):1312974.
13.
NdosiMWright-HughesABrownS, et al. Prognosis of the infected diabetic foot ulcer: A 12-month prospective observational study. Diabetic Med.2018;35(1):78‐88.
14.
FagliaEFavalesFMorabitoA. New ulceration, new major amputation, and survival rates in diabetic subjects hospitalized for foot ulceration from 1990 to 1993: A 6.5-year follow-up. Diabetes Care. 2001;24(1):78‐83.
15.
SongPRudanDWangMChangXRudanI. National and subnational estimation of the prevalence of peripheral artery disease (PAD) in China: A systematic review and meta-analysis. J Glob Health.2019;9(1):010601.
16.
PrompersLSchaperNApelqvistJ, et al. Prediction of outcome in individuals with diabetic foot ulcers: Focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE study. Diabetologia. 2008;51(5):747‐755.
17.
Smith-StrømHIversenMMIglandJ, et al. Severity and duration of diabetic foot ulcer (DFU) before seeking care as predictors of healing time: A retrospective cohort study. PloS one. 2017;12(5):e0177176.
18.
KeeKKNairHKRYuenNP. Risk factor analysis on the healing time and infection rate of diabetic foot ulcers in a referral wound care clinic. J Wound Care.2019;28(Sup1):S4‐s13.
19.
PickwellKSiersmaVKarsM, et al. Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer. Diabetes Care. 2015;38(5):852‐857.
20.
JiangYRanXJiaL, et al. Epidemiology of type 2 diabetic foot problems and predictive factors for amputation in China. Int J Low Extrem Wounds.2015;14(1):19‐27.
21.
American Diabetes A. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003;26(12):3333‐3341.
22.
MarstonWA, Dermagraft diabetic foot ulcer study G. Risk factors associated with healing chronic diabetic foot ulcers: The importance of hyperglycemia. Ostomy Wound Manage. 2006;52(3):26‐28, 30, 32 passim.
23.
JalilianMAhmadi SarbarzehPOubariS. Factors related to severity of diabetic foot ulcer: A systematic review. Diabetes, Metab Syndr Obes: Targets Ther.2020;13:1835‐1842.
24.
WangWZhaoTGengKYuanGChenYXuY. Smoking and the pathophysiology of peripheral artery disease. Front Cardiovasc Med.2021;8:704106.
25.
GhobadiAAhmadi SarbarzehPJalilianMAbdiAManouchehriS. Evaluation of factors affecting the severity of diabetic foot ulcer in patients with diabetes referred to a diabetes centre in kermanshah. Diabetes, Metab Syndr Obes: Targets Ther.2020;13:693‐703.
26.
AdayAWMatsushitaK. Epidemiology of peripheral artery disease and polyvascular disease. Circ Res.2021;128(12):1818‐1832.
27.
ChalyaPLMabulaJBDassRM, et al. Surgical management of diabetic foot ulcers: A Tanzanian university teaching hospital experience. BMC Res Notes.2011;4:365.
28.
YesilSAkinciBYenerS, et al. Predictors of amputation in diabetics with foot ulcer: Single center experience in a large turkish cohort. Hormones (Athens, Greece). 2009;8(4):286‐295.
29.
RennieMYDunhamDLindvere-TeeneLRaizmanRHillRLindenR. Understanding real-time fluorescence signals from bacteria and wound tissues observed with the MolecuLight i:X(TM). Diagnostics (Basel, Switzerland). 2019;9(1):1‐16.
30.
JiangYWangXXiaL, et al. A cohort study of diabetic patients and diabetic foot ulceration patients in China. Wound Repair Regen.2015;23(2):222‐230.
