SynthesisWorld journal of surgery2026
Lower Limb Amputations Among Individuals Living With Diabetes Mellitus in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.
Synthesis in World journal of surgery, 2026. 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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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
10 authors.
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Abstract
backgroundDiabetes-related lower-limb amputation (LLA) is a major global health problem; although rates have declined in some high-income settings, the burden in low- and middle-income countries (LMICs) has not been systematically quantified. This review aimed to estimate the prevalence and incidence of diabetes-related LLA in LMICs, based on available published evidence from community and facility-based populations.
methodsFollowing a PROSPERO-registered protocol (CRD42021238656), we searched Medline, CINAHL, AJOL, Scopus, Embase, and Google Scholar (January 1990-June 2025) for quantitative studies reporting diabetes-related LLA in LMICs from community and facility populations. Data were extracted using Joanna Briggs Institute tools, low-quality studies were excluded from quantitative synthesis, and meta-analyses used the Freeman-Tukey double-arcsine transformation; subgroup analyses (age, sex, WHO region, high-risk groups) explored heterogeneity, and certainty of evidence (CoE) was assessed with GRADE.
resultsOf 201 included studies from 32 LMICs, 121 moderate-to-high-quality studies were meta-analyzed; most were facility-based high-risk cohorts (especially diabetic foot or advanced-complication care). Pooled prevalence was 23 per 100 individuals (95% CI 0.21-0.24; n = 89; moderate CoE), incidence 29 per 100 (95% CI 0.25-0.32; n = 29; low CoE), re-amputation 31 per 100 (95% CI 0.14-0.48; n = 8; low CoE), and contralateral amputation 23 per 100 (95% CI 0.13-0.33; n = 2; very low CoE).
conclusionsDiabetes-related LLA remains a substantial burden in LMICs, while scarce population-based data highlights key surveillance gaps for prevention planning.
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