Identifying factors linked to severe diabetic foot ulcers (DFU) may support earlier intervention in individuals with type 2 diabetes mellitus (T2DM). A cross-sectional study published in Diabetology evaluated demographic, clinical, and behavioral characteristics associated with severe DFU in a hospital-based population in Bangladesh.

The study included 159 patients with DFU attending a tertiary care center. Severe DFU was defined as Wagner grades 3-5, while grades 0-2 were classified as non-severe. Data were collected using structured questionnaires and clinical assessments. Firth’s penalized logistic regression was applied to identify independent predictors, and model performance was evaluated using receiver operating characteristic analysis, calibration belt analysis, and decision curve analysis.

Severe DFU was observed in 63.5% of participants. Compared with non-severe cases, individuals with severe DFU were older (57 vs 54 years), had higher body mass index (26.1 vs 23.7 kg/m²), and incurred higher treatment costs (50,000 vs 20,000 BDT). Peripheral arterial disease (29.7% vs 3.4%), prior amputation (31.7% vs 3.4%), peripheral neuropathy (86.1% vs 58.6%), and poor glycemic control (71.3% vs 30.7%) were more frequent among severe cases (all p<0.05). Independent predictors included older age (aOR 1.08), poor glycemic control (aOR 3.90), peripheral neuropathy (aOR 3.41), peripheral arterial disease (aOR 7.54), and prior amputation (aOR 13.67).

These findings identify multiple clinical factors observed in patients with severe DFU, supporting their consideration in early risk assessment.