Lin SS, Chen CR, Xu WC, Fu J, Xu JQ, Liang ZH. Association between anemia and the risk of diabetic foot ulcer: A meta-analysis. World J Diabetes 2025; 16(6): 105155 [DOI: 10.4239/wjd.v16.i6.105155]
Corresponding Author of This Article
Zun-Hong Liang, MD, Department of Burn and Skin Repair Surgery, Affiliated Hainan Hospital of Hainan Medical University, Hainan General Hospital, No. 19 Xiuhua Road, Xiuying District, Haikou 570311, Hainan Province, China. liangzunhong123@163.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Shi-Shuai Lin, Jia-Qin Xu, Zun-Hong Liang, Department of Burn and Skin Repair Surgery, Affiliated Hainan Hospital of Hainan Medical University, Hainan General Hospital, Haikou 570311, Hainan Province, China
Cun-Ren Chen, Department of Endocrinology, Affiliated Hainan Hospital of Hainan Medical University, Hainan General Hospital, Haikou 570311, Hainan Province, China
Wei-Cheng Xu, Jia Fu, Department of Burn and Skin Repair Surgery, Affiliated Clinical College of Hainan Medical University, Haikou 570311, Hainan Province, China
Co-first authors: Shi-Shuai Lin and Cun-Ren Chen.
Author contributions: Liang ZH and Lin SS designed the study; Chen CR and Xu WC performed database search, data collection, and study quality evaluation; Lin SS and Fu J performed statistical analysis; Xu WC and Fu J interpreted the results; Lin SS and Chen CR wrote the initial draft; Xu JQ and Liang ZH revised the manuscript. All authors read and approved the final version of the manuscript.
Supported by General Program of Hainan Natural Science Foundation, No. 824MS143.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zun-Hong Liang, MD, Department of Burn and Skin Repair Surgery, Affiliated Hainan Hospital of Hainan Medical University, Hainan General Hospital, No. 19 Xiuhua Road, Xiuying District, Haikou 570311, Hainan Province, China. liangzunhong123@163.com
Received: January 14, 2025 Revised: March 7, 2025 Accepted: April 23, 2025 Published online: June 15, 2025 Processing time: 151 Days and 4.3 Hours
Abstract
BACKGROUND
Diabetic foot ulcers (DFUs) are a major complication of diabetes mellitus, and anemia is commonly observed in diabetic patients. However, the relationship between anemia and the risk of developing DFUs remains unclear.
AIM
To investigate the relationship between anemia and the risk of DFUs in diabetic patients through a meta-analysis.
METHODS
A systematic search was conducted across PubMed, Embase, and Web of Science databases to identify studies that reported the co-occurrence of anemia and DFUs in diabetic patients. The primary outcome was an association between anemia and DFU risk, expressed as odds ratios (ORs). Secondary outcomes included the risk of DFU per 1-g/dL decrease in hemoglobin and the difference in hemoglobin levels between patients with and without DFU. Statistical analyses were performed using random-effects models to account for heterogeneity.
RESULTS
Sixteen studies involving 170,949 diabetic patients were included in the analysis. The results indicated a significant association between anemia and an increased risk of DFUs (eight studies, n = 166173, OR: 2.72, 95%CI: 1.73–4.25, P < 0.001; I2 = 93%). Subgroup analyses supported consistent findings across various patient characteristics, analytic models, and study quality scores (P for subgroup differences, all > 0.05). Additionally, each 1-g/dL decrease in hemoglobin was associated with an excess risk of DFUs (four studies, n = 2543, OR: 1.65, 95%CI: 1.21–2.27, P = 0.002; I2 = 68%). Furthermore, diabetic patients with DFUs exhibited significantly lower hemoglobin levels compared to those without DFUs (nine studies, n = 3986, mean difference: -2.13 g/dL, 95%CI: -2.58 to -1.68, P < 0.001; I2 = 90%).
CONCLUSION
Anemia can be associated with an increased risk of DFUs in diabetic patients. Monitoring and managing anemia in diabetic population may help mitigate the risk of DFUs, emphasizing the need for early interventions. Further research is required to investigate the underlying mechanisms and potential therapeutic strategies.
Core Tip: This meta-analysis reveals a significant association between anemia and an increased risk of diabetic foot ulcers (DFUs) in diabetic patients, with an odds ratio (OR) of 2.72. Each 1-g/dL decrease in hemoglobin appears to further elevates DFU risk (OR: 1.65), and diabetic patients with DFUs show significantly lower hemoglobin levels (-2.13 g/dL). These findings highlight the importance of anemia monitoring and management in diabetes care to reduce DFU risk. By providing reasonable evidence from 16 studies involving over 170000 patients, this study underscores the need for early interventions and further research into underlying mechanisms and therapeutic strategies.
