Associations of Glycemic Control, Age, and Sex with Diabetic Foot Risk and Active Foot Ulceration among Patients with Diabetes in Saudi Arabia: A Cross-Sectional Study
9 affiliations
- 1Department of Public Health, College of Applied Medical Sciences, Qassim University, 52571 Buraydah, Saudi Arabia
- 2Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, 51452 Buraydah, Saudi Arabia
- 3Department of Medical Education, College of Medicine, Qassim University, 52571 Buraydah, Saudi Arabia
- 4Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
- 5Department of Family and Community Medicine, College of Medicine, Qassim University, 51452 Buraydah, Saudi Arabia
- 6Abdullah Al-Othaim Diabetes Center, Medical City, Qassim University, 51452 Buraydah, Saudi Arabia
- 7Department of Nursing, Mental Health Hospital, Qassim Health Cluster, 52571 Buraydah, Saudi Arabia
- 8Department of Nursing, Faculty of Health Science, University of Pretoria, Pretoria, 0084 South Africa
- 9CBIOS (Research Center for Biosciences and Health Technologies), ECTS (School of Health Sciences and Technologies), Lusófona University, Campo Grande 376, 1749-024 Lisboa, Portugal
Abstract
Introduction: Diabetic foot disease is one of the most severe complications of diabetes mellitus, contributing substantially to hospitalization, lower limb amputation, and premature mortality. This study evaluated the associations of glycemic control (glycated hemoglobin [HbA1c]), age, and sex with diabetic foot risk and ulceration among patients attending a tertiary diabetes center in Qassim, Saudi Arabia.
Methods: This retrospective cross-sectional study included a census sample of 710 eligible electronic medical records of patients with a confirmed diagnosis of diabetes mellitus and a documented diabetic foot assessment between January 2022 and December 2024. No a priori sample size calculation was performed. The primary outcome was at-risk diabetic foot status (International Working Group on the Diabetic Foot category ≥ 1), and the secondary outcome was active foot ulceration. Multivariable logistic regression was used to identify factors independently associated with each outcome.
Results: The mean age was 57.6 ± 14.0 years; 337 patients (47.5%) were male and 373 (52.5%) were female, and 93.2% had type 2 diabetes mellitus. At-risk diabetic foot status was present in 53.2% of patients, and active foot ulceration was present in 3.0%. Ulcer prevalence increased across HbA1c categories (1.9%, 2.6%, and 6.3%), and at-risk status increased with age (39.6–62.1%). Older age (odds ratio [OR] = 1.028; 95% confidence interval [CI] 1.016–1.039; P < 0.001) and male sex (OR = 1.403; 95% CI 1.036–1.901; P = 0.029) were independently associated with the at-risk status. HbA1c was not independently associated with at-risk status (P = 0.422) or ulceration (P = 0.077).
Conclusions: Ulcer prevalence increased with poorer glycemic control; however, the adjusted HbA1c–ulceration association was not significant in the primary model. Key confounders were unavailable in the dataset, including diabetes duration, neuropathy and peripheral arterial disease severity, and renal function. Therefore, residual confounding cannot be excluded, and HbA1c’s role in diabetic foot risk should not be discounted. These findings suggest that diabetic foot screening and preventive care should be tailored to specific age and sex groups, involving multiple healthcare disciplines.
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BibTeX
@article{alenazi2026associations,
title = {{Associations of Glycemic Control, Age, and Sex with Diabetic Foot Risk and Active Foot Ulceration among Patients with Diabetes in Saudi Arabia: A Cross-Sectional Study}},
author = {Fatimah Z. Alenazi and Thamer Alslamah and Basmah Alharbi and Wafa I. Alotaibi and Mirna Fawaz and Metab Algeffari and Yasir S. Alsalamah and António Raposo},
journal = {Diabetes Therapy},
year = {2026},
month = oct,
doi = {10.1007/s13300-026-01923-y},
url = {https://doi.org/10.1007/s13300-026-01923-y},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Associations of Glycemic Control, Age, and Sex with Diabetic Foot Risk and Active Foot Ulceration among Patients with Diabetes in Saudi Arabia: A Cross-Sectional Study
AU - Fatimah Z. Alenazi
AU - Thamer Alslamah
AU - Basmah Alharbi
AU - Wafa I. Alotaibi
AU - Mirna Fawaz
AU - Metab Algeffari
AU - Yasir S. Alsalamah
AU - António Raposo
PY - 2026
DA - 2026/10/09
JO - Diabetes Therapy
DO - 10.1007/s13300-026-01923-y
UR - https://doi.org/10.1007/s13300-026-01923-y
AB - Introduction: Diabetic foot disease is one of the most severe complications of diabetes mellitus, contributing substantially to hospitalization, lower limb amputation, and premature mortality. This study evaluated the associations of glycemic control (glycated hemoglobin [HbA1c]), age, and sex with diabetic foot risk and ulceration among patients attending a tertiary diabetes center in Qassim, Saudi Arabia. Methods: This retrospective cross-sectional study included a census sample of 710 eligible electronic medical records of patients with a confirmed diagnosis of diabetes mellitus and a documented diabetic foot assessment between January 2022 and December 2024. No a priori sample size calculation was performed. The primary outcome was at-risk diabetic foot status (International Working Group on the Diabetic Foot category ≥ 1), and the secondary outcome was active foot ulceration. Multivariable logistic regression was used to identify factors independently associated with each outcome. Results: The mean age was 57.6 ± 14.0 years; 337 patients (47.5%) were male and 373 (52.5%) were female, and 93.2% had type 2 diabetes mellitus. At-risk diabetic foot status was present in 53.2% of patients, and active foot ulceration was present in 3.0%. Ulcer prevalence increased across HbA1c categories (1.9%, 2.6%, and 6.3%), and at-risk status increased with age (39.6–62.1%). Older age (odds ratio [OR] = 1.028; 95% confidence interval [CI] 1.016–1.039; P < 0.001) and male sex (OR = 1.403; 95% CI 1.036–1.901; P = 0.029) were independently associated with the at-risk status. HbA1c was not independently associated with at-risk status (P = 0.422) or ulceration (P = 0.077). Conclusions: Ulcer prevalence increased with poorer glycemic control; however, the adjusted HbA1c–ulceration association was not significant in the primary model. Key confounders were unavailable in the dataset, including diabetes duration, neuropathy and peripheral arterial disease severity, and renal function. Therefore, residual confounding cannot be excluded, and HbA1c’s role in diabetic foot risk should not be discounted. These findings suggest that diabetic foot screening and preventive care should be tailored to specific age and sex groups, involving multiple healthcare disciplines.
SN - 1869-6953
SN - 1869-6961
ER -