Quality of life and its specific domains in patients with diabetic foot ulcers: a systematic review and meta-analysis

Diabetic foot ulcers (DFUs) are a severe complication of diabetes, affecting 15–25% of patients and significantly impairing quality of life (QoL) due to pain, reduced mobility, and psychological distress. The global rise in diabetes has increased DFU prevalence, particularly in resource-limited settings, posing a major public health challenge. This study investigates the multifaceted determinants of QoL in DFU patients. A systematic review and meta-analysis were conducted following PRISMA guidelines. Studies from conception to the end of March, 2026 were sourced from PubMed, Scopus, ProQuest, Web of Science, and Embase, focusing on adults with DFUs and QoL assessed via validated tools. Inclusion required observational designs reporting clinical, sociodemographic, or psychological factors affecting QoL. Two reviewers independently screened, extracted data, and assessed quality using the Newcastle-Ottawa Scale. A random-effects meta-analysis pooled QoL scores, with subgroup and sensitivity analyses exploring heterogeneity. Effect sizes for key factors were calculated, and publication bias was evaluated. From 1,085 articles, 20 studies (6 prospective, 14 cross-sectional) across 10 countries were included, with 11 in the meta-analysis. The mean QoL score was 50.21 (95% CI: 44.50-55.92), with high heterogeneity (I² = 98.39%, p < 0.001). Pain, wound severity, and psychological distress (e.g., depression, anxiety) significantly reduced QoL, while social support and employment improved it. Among domain-specific scores, bodily pain (PCS) and social function (MCS) exhibited the highest pooled mean scores within their respective components. Subgroup analyses by age and QoL domains showed no significant differences, and no publication bias was detected (Egger’s p = 0.66). Sensitivity analyses confirmed robust findings across 11 factors. DFUs profoundly impair QoL, driven by physical, psychological, and social factors, necessitating holistic care approaches. Pain management, mental health support, and enhanced social resources are critical to improve outcomes. Findings related to pain should be interpreted with caution given the heterogeneity of sensory perception in neuropathic versus ischemic ulcers. Future research should standardize QoL assessments and explore longitudinal impacts. Not applicable.