Diabetic foot complications - Vitamin D is the only changeable factor - umbrella of meta-analyses
Quantifying the evidence on associated factors for diabetes-related foot complications: An umbrella review of published systematic reviews and meta-analyses
Diabetes Res Clin Pract 2026 Jun 6:113353. doi: 10.1016/j.diabres.2026.113353 PDF behind paywall
Xiaoman Yang 1, Jing Guo 2, Ting Wei 3, Peihao Liu 1, Qing Cai 1, Rongrong Wang 4, Yan Hu 5
Diabetes-related foot complications, defined in this review as diabetic foot ulceration and diabetes-related lower-extremity amputation, remain among the most disabling and costly consequences of diabetes. Evidence on their associated factors is dispersed across multiple systematic reviews and meta-analyses. This umbrella review synthesized, quantified and graded published evidence on indicators associated with diabetes-related foot complications. Nine English and Chinese databases were searched from inception to March 2025. Methodological quality was assessed using AMSTAR 2, overlap between reviews was examined with factor-specific corrected covered area, and second-order meta-analysis was performed where appropriate. The protocol was pre-registered on PROSPERO (CRD420251127620).
Twenty-one reviews were included, covering 32 indicators across demographic, physical, foot-related, psychological and behavioral domains. Diabetic nephropathy and diabetic retinopathy showed the most credible associations, both supported by Class I evidence.
Diabetic peripheral neuropathy, male sex, higher HbA1c, vitamin D deficiency < 50 nmol/L, older age and longer diabetes duration were supported by Class II evidence. Most associations concerned DFU, while smoking and outpatient adherence were linked to LEA and male sex to both outcomes. These findings suggest that DFU and diabetes-related LEA reflect a layered risk structure involving systemic microvascular burden, metabolic exposure, local foot vulnerability and care-related behaviors, supporting broader risk stratification.