One severe and frequent side effect of diabetes mellitus is diabetic foot ulcers (DFUs), which can result in extended hospital stays, higher medical expenses, and an increased risk of lower limb amputations [1].DFUs are most common in people with peripheral neuropathy, peripheral arterial disease, and poorly managed diabetes [2].Usually, a combination of neuropathy, persistent hyperglycemia, and compromised vascular supply leads to the development of these ulcers [3]. Advanced wound care procedures have led to an evolution in the management of DFUs. Therapies like negative-pressure wound therapy (NPWT), sophisticated dressings, and offloading techniques are increasingly used in addition to traditional procedures. By eliminating exudate, decreasing edema, and enhancing circulation, NPWT aids in the healing process. Advanced dressings, such as hydrocolloid and alginate dressings, promote tissue regeneration and hasten wound closure by forming a moist environment. Despite these developments, it is still difficult to ensure that every patient heals as well they can because of variables including wound size, depth, infection, and comorbidities. Thus, it is crucial to continuously assess healing and complication rates in order to enhance patient care and treatment methods. Notwithstanding these developments, healing rates are still erratic and dependent on a number of patient-specific variables, including glycemic management, the length of diabetes, concomitant conditions such peripheral neuropathy and peripheral vascular disease, and the existence of osteomyelitis or infection. Research has demonstrated a clear correlation between delayed healing and increased complication rates and poor glycemic control, longer ulcer duration, higher Wagner grades, and a history of prior ulcers or amputations. Improving results requires both structured advanced wound care therapies and early identification of these risk factors. Assessing the healing and complication rates in DFUs is crucial for determining patient populations at increased risk of negative outcomes as well as for evaluating the efficacy of different

Type of Study: This is a prospective observational study Place of Study: Study Duration: From 1st February 2023 to 31st January 2024 Sample Size: 50 diabetic foot ulcers patients Inclusion Criteria: • Patients of either gender aged ≥18 years with a diagnosis of diabetes mellitus. • Patients presenting with foot ulcers of any Wagner grade requiring advanced wound care. • Patients with ulcers of at least 1-week duration. • Patients willing to provide informed consent and comply with follow-up visits. • Patients with controlled or uncontrolled diabetes, irrespective of treatment modality. Exclusion Criteria: • Patients with foot ulcers of non-diabetic etiology. • Patients with severe systemic infections or sepsis requiring immediate intensive care. • Patients with critical limb ischemia not suitable for wound care alone. • Patients with severe comorbidities limiting participation or follow-up. • Pregnant or lactating women. Study Variables: • Age • Gender • Body mass index (BMI) • Type and duration of diabetes • Wagner grade of ulcer Statistical Analysis: Data were entered into excel and analyzed using SPSS and Graphpad prism. Numerical variables were summarized using means and standard deviations, while categorical variables were described with counts and percentages. Two-sample t-tests were used to compare independent groups, while paired t-tests accounted for correlations in paired data. Chi-square tests (including fisher’s exact test for small sample sizes) were used for categorical data comparisons. P-values ≤ 0.05 were considered statistically significant.

Table 1: Distribution of Basic Characteristics of the patients Characteristic Category Patients Number Percentage (%) P- value Gender Male 30 60.00% Female 20 40.00% .0455 BMI Normal 10 20.00% <.00001 Overweight 30 60.00% Obese 10 20.00% Type of Diabetes (DM) Type 1 15 30.00% .00006 Type 2 35 70.00% Treatment of DM Oral antidiuretic 18 36.00% <.00001 Insulin 18 36.00% Combined therapy 13 26.00% No treatment 1 2.00% HbA₁c Level <7% 7 14.00% <.00001 >7% 43 86.00% Infection (clinical) Present 30 60.00% .0455 Absent 20 40.00% Table 2: Distribution of Risk Factor of the patients Risk Factor Number of Patients Percentage P- value Duration of Diabetes > 10 years 28 56% < .00001 Poor Glycemic Control (HbA1c >8%) 32 64% Peripheral Neuropathy 40 80% Peripheral Arterial Disease 22 44% Previous Foot Ulcer 18 36% History of Amputation 10 20% Osteomyelitis 14 28% Wound Duration > 4 weeks 34 68% Wagner Grade ≥ 3 20 40% Advanced Wound Care Used 50 100% Figure 1: Risk Factor of the patients In the present study comprising 50 diabetic patients, males were 30 (60%) and females 20 (40%), showing a statistically significant gender difference (p = 0.0455). Based on BMI, 10 patients (20%) had normal weight, 30 (60%) were overweight, and 10 (20%) were obese, with a highly significant difference (p < 0.00001). Regarding the type of diabetes, 35 patients (70%) had Type 2 DM and 15 (30%) had Type 1 DM (p = 0.00006). For treatment, 18 patients (36%) were on oral antidiabetic drugs, 18 (36%) on insulin, 13 (26%) received combined therapy, and 1 (2%) was not on any treatment (p < 0.00001). Glycemic control assessment showed that 7 patients (14%) had HbA₁c <7%, while 43 (86%) had HbA₁c >7% (p < 0.00001). Clinically, infection was present in 30 patients (60%) and absent in 20 (40%), indicating a significant association (p = 0.0455). In our study several significant risk factors were identified. A majority, 28 patients (56%), had a duration of diabetes exceeding 10 years, showing a strong association with diabetic foot complications (p < 0.00001). Poor glycemic control (HbA₁c >8%) was observed in 32 patients (64%), reflecting inadequate metabolic control. Peripheral neuropathy was the most common comorbidity, present in 40 patients (80%), while peripheral arterial disease affected 22 patients (44%). A previous history of foot ulcer was reported by 18 patients (36%), and 10 patients (20%) had a prior amputation. Osteomyelitis was documented in 14 patients (28%). Additionally, 34 patients (68%) had wounds persisting for more than 4 weeks, and 20 patients (40%) presented with Wagner grade ≥3 ulcers, indicating advanced disease. All patients (100%) received advanced wound care

Several studies support our observations regarding the demographic and clinical characteristics of diabetic patients. Anderson et al. (2015) reported that males are more likely to have elevated fasting plasma glucose and HbA₁c, consistent with our finding that the majority of patients were male (30; 60%) compared to females (20; 40%) [4]. Noor et al. (2025) found that overweight and obese patients had higher HbA₁c levels, supporting our observation that most patients were overweight (30; 60%) with poor glycemic control (HbA₁c >7% in 43; 86%) [5]. Carey et al. (2024) demonstrated that poor glycemic control is associated with increased risk of infections in diabetic patients, aligning with our finding of clinical infection in 30 (60%) patients [6]. Additionally, Chua et al. (2024) and Al Ozairi et al. (2024) reported that Type 2 diabetes and longer disease duration are linked to higher HbA₁c levels and greater infection risk, corroborating our results showing a predominance of Type 2 diabetes (35; 70%) and significant associations with male gender, poor glycemic control, and infection [7,8]. We found that the highest number of patients had peripheral neuropathy 40 (80%), followed by poor glycemic control (HbA₁c >8%) 32 (64%), wound duration >4 weeks 34 (68%), and duration of diabetes >10 years 28 (56%), all showing significant associations (p < 0.00001 for duration of diabetes). Peripheral arterial disease was present in 22 (44%), Wagner grade ≥3 ulcers in 20 (40%), previous foot ulcer in 18 (36%), osteomyelitis in 14 (28%), and history of amputation in 10 (20%) patients. Importantly, all patients 50 (100%) received advanced wound care. These results align with studies by Boulton et al. (2005) and Singh et al. (2008), which highlighted peripheral neuropathy, poor glycemic control, and longer diabetes duration as the most prevalent risk factors for diabetic foot ulcers [9,10]

We concluded that the majority of patients with Type 2 diabetes were male, overweight, and had poor glycemic control in this study assessing healing and complication rates in diabetic foot ulcers with advanced wound care. Key risk factors influencing healing were highlighted by the prevalence of clinical infection and peripheral neuropathy, as well as long-standing diabetes and prolonged wound duration. Advanced wound care was provided to all patients, which aided in promoting positive healing outcomes and slowing the development of problems. To maximize healing and lower complication rates in patients with diabetic foot ulcers, these data highlight the significance of early intervention, stringent glycemic control, and focused management of neuropathy and vascular disease.

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