At 6 months, healing rates for diabetic foot ulcers were 48%, with multivariable analysis revealing ethnic group and impossibility of revascularization as independent predictors of non-healing, and previous major amputation, osteomyelitis, and white blood cell count as independent predictors of amputation.
At 6 months, less than half of diabetic foot ulcer patients achieved wound healing, with notable rates of amputation and death.
Ethnic group and impossibility of revascularization were identified as independent predictors of non-healing in multivariable analysis.
Previous major amputation, presence of osteomyelitis, and white blood cell count were independent predictors of amputation.
Implementation of international guidelines for diabetic foot care was suboptimal prior to patients reaching the tertiary care center.
The study cohort was composed predominantly of older patients with type 2 diabetes mellitus presenting with wounds of variable duration.
Limb ischemia was highly prevalent in the cohort, but revascularization was performed in only a minority of affected patients.
This research suggests that diabetic foot ulcers remain difficult to treat effectively, even in a specialized tertiary care setting. In a group of 90 patients treated at one center over roughly seven months, only about half had their wounds healed after six months, and a notable proportion required amputation, died, or remained unhealed. A key concern highlighted by the study was that many patients arrived at the specialist center after long delays, having previously been managed by general practitioners, wound clinics, or even themselves — and most had not received recommended care such as pressure-relieving devices or referral to vascular surgeons. The study identified several factors that made outcomes worse. Patients who could not undergo a procedure to restore blood flow to their feet (revascularization) were much less likely to heal, which is significant given that nearly half of all patients had reduced blood supply to their limbs. Patients from certain ethnic groups also had worse healing outcomes, though the paper does not detail why. For those who required amputation, having had a previous major amputation, having a bone infection (osteomyelitis), and elevated white blood cell counts were all associated with higher amputation risk. This research suggests that outcomes for people with diabetic foot ulcers could be substantially improved through better implementation of existing international care guidelines at every level of the healthcare system — from family doctors through to specialist centers. The authors emphasize the need for regular preventive foot care for high-risk diabetes patients, earlier referral to specialists when ulcers develop, greater availability of wound clinics, and improved access to vascular surgery for patients with poor circulation.
Gurevich M, Udovichenko O, Kabha N, Takrori L, Ben Natan M, Behrbalk E. (2026). Efficacy of Diabetic Foot Ulcer Treatment and Possible Ways for Improvement: A Retrospective Cohort Study.. The Israel Medical Association journal : IMAJ. https://pubmed.ncbi.nlm.nih.gov/42867096/