Anemia Prevalence Among Patients With Diabetic Foot Ulcers Necessitating Surgery on Admission

A Preliminary, Retrospective Comparative Study

Kaissar Yammine, MD, MPH, PhD; Sandra Akiki, BSc; Chahine Assi, MD; Fady Hayek, MD


Wounds. 2022;34(8):216-219. 

In This Article

Abstract and Introduction


Introduction: Anemia is significantly more prevalent in patients with diabetic foot complications. Severity of anemia has been shown to be associated with severity of DFD. The association between Hb level and DFU has rarely been investigated in surgical settings.

Objective: This study compares Hb level in patients undergoing conservative surgical treatment of DFU based on initial status of infection.

Materials and Methods: Retrospective comparative analysis was made between 2 groups of patients based on the presence or absence of infection in the diabetic wounds.

Results: Of the 37 patients studied, 21 had noninfected ulcers and 16 had infected ulcers. The mean Hb levels for the noninfected group and the infected group were 11.7 g/dL ± 2.4 and 10.3 g/dL ± 2.1, respectively (P =.033). A positive correlation was found between Hb level and DFU severity (ie, noninfected vs. infected) (P =.03). For other risk factors, a high correlation was recorded between Hb and serum creatinine level only (P =.025).

Conclusions: Patients with an infected DFU and those with impaired renal function were more likely to have lower Hb levels. In such patients, early evaluation of Hb levels with subsequent treatment based on those values might positively affect clinical outcomes.


Anemia is more common among patients with diabetes compared with the general population, even after adjusting for renal function.[1–3] Based on the WHO sex-specific definitions of anemia as Hb less than 12 g/dL in women and less than 13 g/dL in men, up to 23% of patients with diabetes could be classified as having anemia.[2,4] Variables such as HbA1c and C-reactive protein, as well as risk factors such as albuminuria and diabetes duration, are associated with low levels of Hb.[5,6] In the presence of altered microcirculation, anemia is considered to be an aggravating factor for wound healing, ulcer infection, lower extremity amputation, and death.[6,7]

A recent meta-analysis demonstrated a clear association between the presence of anemia and DFUs; anemia was significantly more prevalent in patients with diabetes and foot complications compared to those with diabetes but without foot complications (P =.01).[8] The same authors concluded that the severity of anemia was also associated with the severity of DFD.[8] To the current authors' knowledge, only 2 studies have reported such an association among patients who required amputation owing to DFD.[9,10] No studies were identified that included patients who had undergone conservative surgery as the initial management of foot complications. Furthermore, in the Middle East region, late presentation to a health care provider is common; a recently published study noted that patients had advanced DFUs at the first consultation, which often necessitated admission for surgery.[11]

This retrospective pilot study is an attempt to determine a possible relationship between DFD severity and anemia among a homogenous series of patients who underwent surgical treatment on their first admission. Therefore, the primary purpose of this preliminary report is to look for a potential association between Hb level and the severity of DFD using comparative subgroups of infected vs. noninfected DFUs.