ReviewScience progress
Differential burden of diabetic foot ulcers in individuals with type 1 and type 2 diabetes: A narrative review of prevalence, healing, recurrence, and outcomes.
Review in Science progress. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
6 authors.
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Abstract
Diabetic foot ulcers (DFUs) are a major cause of morbidity and mortality in people with diabetes. Understanding differences in DFU burden and outcomes between T1DM and T2DM is important for advancing precision medicine. This narrative review summarizes evidence reporting DFU prevalence, healing, recurrence, infection, and lower extremity amputation outcomes separately in T1DM and T2DM. Population surveys suggest a higher lifetime prevalence in T1DM, driven by longer disease duration, whereas registry-based and database studies generally report higher annual incidence rates in T2DM, reflecting older age and macrovascular comorbidities. Crucially, most included studies lacked the multivariable adjustment and statistical power necessary to isolate diabetes type as an independent prognostic driver. Consequently, a lack of statistically significant differences should not be misinterpreted as proof of clinical equivalence. Overall, the available evidence suggests that time to healing does not differ substantially between individuals with T1DM and T2DM, though outcomes were primarily driven by local wound characteristics and vascular status. Recurrence is frequent and remains a clinical challenge irrespective of diabetes type, although people with T2DM may experience a greater burden. Evidence further indicates that the risk of LEAs is increased in both T1DM and T2DM, although the magnitude and comparative contribution of each diabetes type varies across populations and study designs, with real-world clinical cohorts indicating that advanced age and a neuro-ischemic phenotype in T2DM drive substantial post-ulcer morbidity. Finally, a higher relative risk of deep bone infections (osteomyelitis) emerges as one of the most severe diabetes-related foot infections and is associated with poor outcomes, with several reports suggesting a particularly pronounced burden among people with T1DM. Differences in DFU burden and outcomes between T1DM and T2DM appear to be driven more by patient phenotype than diabetes type itself. Precision-medicine approaches may help improve future prevention and management strategies.
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