Commentary on “Prevalence of Diabetic Foot Ulcer and Determinant Factors Among Adult Diabetic Patients Who Attend the Diabetic Follow-Up at Adwa General Hospital, Ethiopia, 2019: A Cross-Sectional Study”

We read with much interest the article titled “Prevalence of Diabetic Foot Ulcer and Determinant Factors Among Adult Diabetic Patients Who Attend the Diabetic Follow-Up at Adwa General Hospital, Ethiopia, 2019: A Cross-sectional Study” published in your journal [1]. The purpose of the study was to assess the prevalence and determinant factors of diabetic foot ulceration among adult diabetic patients who presented for diabetic follow-up in 2019 at Adwa General Hospital, Ethiopia. They found a significantly high prevalence of diabetic foot ulcers. Determinants included rural residence, use of oral hypoglycemic drugs, medication nonadherence, poor diabetic foot self-care practices, loss to follow-up, neuropathy and alcohol consumption. We thank the authors for their significant contributions to this vital question. Nevertheless, we believe that some limitations deserve highlighting, as addressing them would strengthen the study's overall impact and validity.

First, the study lacked information on key laboratory parameters that would have given more depth to the patient outcomes. Markers like C-reactive protein, erythrocyte sedimentation rate, lipid profiles, liver function tests, albumin, vitamin B12, vitamin D, platelet-to-lymphocyte ratio, and neutrophil-to-lymphocyte ratio may have provided a more thorough understanding of the risk factors and prognosis [2, 3].

Second, the study lacked sufficient adjustment for underlying comorbidities, including cerebrovascular diseases, malignancies, diabetic retinopathy, chronic liver disease, immune deficiencies, and autoimmune diseases. Such conditions could significantly affect patient outcomes and also induce bias in the findings.

Third, more data on medications given to patients, such as antibiotics, antihyperlipidemic agents, and antihypertensives, would be valuable. Details related to these treatments, including types, dosage, and duration, could shed some light on the potential effect of these interventions on diabetic foot ulcer outcomes.

Fourth, detailed demographic data were absent. Socioeconomic factors, such as income level, smoking history (current, former, and heavy smokers), opium intake, and previous amputation history, are potentially essential indicators of patient risk profiles. Other limitations include poor data on nutritional status, vascular health, and insulin resistance, which are more significant points crucial in the management of diabetic foot ulcers [4].

Therefore, in closing, we recognize the value of this study in understanding the prevalence and determinants of diabetic foot ulcers in the adult diabetic population. However, the limitations suggested above, when addressed, have the potential to significantly strengthen the validity and applicability of the findings. We hope that the authors will consider these critiques, as we believe that such improvements are needed to advance research in this area further.

Mostafa Javanian: conceptualization, investigation. Mohammad Barary: writing – review and editing, writing – original draft, investigation. Mehran Shokri: Investigation, writing – original draft. Fatemeh Rasulpur: investigation, writing – original draft. Soheil Ebrahimpour: investigation, supervision, writing – original draft.

No ethical approval was required as this letter-to-the-editor article has no original research data.

The authors declare no conflicts of interest.