Determinants of Diabetic Foot Ulcer Severity: The Role of Arterial Occlusion and Glycemic Markers

Abstract

Background: Diabetic foot ulcer (DFU) is a serious complication of diabetes mellitus, often leading to infection, hospitalization, and lower limb amputation. Peripheral arterial disease (PAD) and poor glycemic control are considered important risk factors of DFU severity. Objectives: this study aimed to assess the association between arterial occlusion, glycated hemoglobin (HbA1C), hemoglobin (Hb) concentration, age, and sex and the severity of DFU. Methods: In this cross-sectional study, we evaluated 205 patients with DFU who were admitted to Alzahra Hospital, Isfahan, between March 2021 and March 2023. Demographic data, arterial occlusion status, HbA1C, Hb, and DFU severity were extracted from medical records. Statistical analyses were done using analysis of variance (ANOVA), chi-square, and multiple ordinal logistic regression. Results: Among 205 patients (68.8% male; mean age 59.5 ± 11.1 years), DFU severity was mild in 32.2%, moderate in 56.6%, and severe in 11.2%. Arterial occlusion was present in 65.2% of those assessed and was significantly associated with higher DFU (OR = 3.47; 95% Cl: 1.26 - 9.58; P < 0.05). Higher HbA1C levels were also associated with increased DFU severity (OR = 1.44; 95% CI: 1.16 - 1.77; P < 0.05), whereas elevated Hb levels were independently correlated with reduced odds of DFU (OR = 0.68; 95% Cl: 0.52 - 0.88; P < 0.05). Age and sex showed no significant association with DFU severity. Conclusions: Arterial occlusion, HbA1C, and Hb are associated with DFU severity. These findings underscore the potential relevance of vascular assessment, glycemic control, and anemia monitoring in the clinical evaluation of patients with DFU.