Quantifying the evidence on associated factors for diabetes-related foot complications: An umbrella review of published systematic reviews and meta-analyses
Authors' conclusion
These findings suggest that DFU and diabetes-related LEA reflect a layered risk structure involving systemic microvascular burden, metabolic exposure, local foot vulnerability and care-related behaviors, supporting broader risk stratification.
Study context
- Population
- Published systematic reviews and meta-analyses on factors associated with DFU and diabetes-related lower-extremity amputation (LEA); 9 English and Chinese databases searched from inception to March 202521 reviews
- Outcome
- Credibility of associations of 32 indicators with diabetes-related foot complications
Methodological detailsAMSTAR 2 quality assessment, factor-specific corrected covered area, second-order meta-analysis, pre-registered protocol
- AMSTAR 2 quality assessment
- Factor-specific corrected covered area
- Second-order meta-analysis
- Pre-registered protocol
Pooled result
As reported in the abstract
- Diabetic nephropathy and DR: most credible associations, Class I evidence
- Diabetic peripheral neuropathy, male sex, higher HbA1c, vitamin D deficiency < 50 nmol/L, older age and longer diabetes duration: Class II evidence
Further pooled results
- Most associations concerned DFU; smoking and outpatient adherence linked to LEA; male sex to both outcomes
Original publication
Quantifying the evidence on associated factors for diabetes-related foot complications: An umbrella review of published systematic reviews and meta-analyses. Diabetes Res Clin Pract. Published 6 June 2026. doi:10.
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