Abstract

Among the most debilitating consequences of diabetes mellitus, diabetic foot ulcers (DFUs) and diabetes-related stress (DD) contribute significantly to cause significant morbidity, healthcare expenses, and decreased quality of life. Emphasizing behavioral, clinical, and socioeconomic determinants, this review seeks to integrate recent data on the sample demographics, DFU/DD prevalence, behavioral and clinical results, and statistically significant risk factors, and clinical correlations of DFUs and DD across several populations, especially from Middle Eastern, African, and South Asian groups. Ten observational studies published between 2013 and 2025 were descriptively synthesized. The dually examined studies showed DFU incidence ranging from 1.2% in vast population screenings to more than 80% in clinical groups with a pooled prevalence of 52% (95% CI: 21%-82%). Up to 48.6% of patients, particularly older adults and women, suffered from diabetes-related stress. Common risk factors for DFUs include peripheral neuropathy, poor foot hygiene, obesity, deformities, smoking, rural residence, and lack of family or educational support. Poor glycemic control, advanced age, and multiple comorbidities were consistently associated with increased risk of foot complications and microvascular sequelae. Behavioral factors such as sedentary lifestyle, irregular foot inspection, and infrequent clinical follow-up also significantly contributed to poor outcomes. Early detection of high-risk people, thorough foot treatment education, blood pressure and glucose optimization, and family and community support system participation are all essential for prevention and better outcomes; hence, diabetic foot complications and diabetes distress are prevalent, multifactorial problems requiring integrated and proactive management strategies.

Key words: Diabetic foot ulcers, diabetes distress, elderly patients, risk factors, systematic review