Burden and Associated Factors of Diabetic Foot Complications in a Tertiary Referral Cohort Between 2021 and 2024 in the Qassim Region, Saudi Arabia: A Retrospective Cross‐Sectional Study

Abstract

Abstract

ABSTRACT Diabetic foot complications, including ulcers, infections, and amputations, remain a major cause of morbidity among individuals with diabetes, primarily driven by neuropathy and peripheral vascular disease. Despite being largely preventable, their burden remains substantial, particularly in high‐risk populations. To assess the burden and associated factors of diabetic foot complications among patients attending a tertiary diabetes centre in the Qassim region, Saudi Arabia, between 2021 and 2024. A retrospective cross‐sectional study was conducted using medical record data from 4119 patients attending a tertiary referral diabetes and endocrinology centre. Standardised clinical and demographic data were extracted and analysed to estimate the burden of diabetic foot complications and examine associated factors. The mean age of the participants was 58.8 ± 10.8 years; 60.5% were male, and 97.8% had type II diabetes. The mean BMI was 28.2 ± 2.9 kg/m 2 , and the mean HbA1c level was 8.9% ± 2.1%. Hypertension was present in 78.9% of participants. Foot ulcers were identified in 65.4% of patients, and 41.2% had a history of lower‐extremity amputation. Multivariable logistic regression analysis demonstrated that age, male sex, type II diabetes, smoking, hypertension, elevated BMI, higher HbA1c levels, and lack of participation in diabetes‐related educational programs were independently associated with amputation. Male patients had higher adjusted odds of amputation than females (AOR = 1.48, 95% CI: 1.23–1.79), while type II diabetes was independently associated with higher odds of amputation (AOR = 1.41, 95% CI: 1.02–2.07). A high burden of diabetic foot complications was observed in this tertiary referral cohort, likely reflecting the concentration of advanced and complex cases. Older age, male sex, type II diabetes, smoking, hypertension, elevated BMI, higher HbA1c levels, and lack of participation in diabetes‐related educational programs were independently associated with lower‐extremity amputation. These findings highlight the importance of earlier referral of high‐risk patients, strengthening diabetic foot screening within primary healthcare settings, and enhancing multidisciplinary foot care services to prevent progression to advanced disease and reduce avoidable amputations. However, given the retrospective cross‐sectional design, the reported findings should be interpreted as associations rather than causal relationships.