Evaluation of outcomes in patients with diabetic foot ulcers based on initial assessment at admission

Abstract

Objective: To determine the probable outcome of diabetic foot ulcers in hospitalized patients based on the initial evaluation.

Methodology: A cross-sectional study was conducted in the Endocrinology department, HMC Peshawar, Pakistan, from June 26  to December 26, 2025.  Consecutive sampling was used to cover 108 individuals who had been admitted with DFU. Clinical, laboratory, and demographic information was gathered, including the duration of diabetes, Wagner grade, peripheral pulses, HbA1c, total leukocyte count (TLC), and foot X-ray results. The results were divided into four categories: below-knee amputation (BKA), forefoot/midfoot amputation, toe amputation, and conservative care. Analysis of Data was done by using Chi-square tests and multinomial logistic regression (p ≤ 0.05).

Results: Most patients were male (63%) and aged 41–70 years (85.2%). Diabetes duration >10 years was present in 63.9% and poor glycemic control (HbA1c >7.5%) was observed in 90.8% of patients. Wagner grade and X-ray evidence of osteomyelitis were strongly linked to poorer  outcomes (p <0.001 and p 0.027  respectively). Multinomial regression identified Wagner grade as the strongest predictor of amputation (BKA: OR 6.50; TOE: OR 3.12). X-ray findings were independently associated with toe amputation (OR 0.33).

Conclusion: Initial ulcer severity and bone involvement on X-ray strongly predict amputation in hospitalized patients. Timely identification and aggressive treatment of severe ulcers may reduce limb loss.