Abstract
BACKGROUND: Diabetic foot ulcer (DFU) is a serious complication of diabetes that is associated with an increased risk of amputation and morbidity. Early identification and management are essential to prevent DFU and its complications. This study aimed to determine the prevalence and associated factors of DFU among diabetic patients attending primary healthcare centers (PHC) in Bahrain. MATERIALS AND METHODS: A cross-sectional study was conducted across all PHCs in Bahrain between July and September 2025 using a cluster sampling technique. Adults with diabetes attending diabetes clinics were included. Data on demographics, comorbidities, clinical examination, laboratory values, and treatment were collected using a standardized form. Wagner's classification was used to grade the severity of DFUs after clinical assessment. RESULTS: A total of 601 patients were included, with a median age of 61 years; most were males (56.6%), Bahraini (85.4%), and had type 2 diabetes (96.7%). Dyslipidemia (77.5%), hypertension (66.7%), and ischemic heart disease (10.1%) were the most common comorbidities. DFU was noted in 5.3% (n=32) of the participants; 15 had superficial ulcers, 10 had deep ulcers, and seven had amputated limbs/toes. In multivariable logistic regression, insulin use (OR 2.555, p = 0.042), ischemic heart disease (OR 3.752, p = 0.016), and skin changes (OR 8.166, p < 0.001) were independently associated with DFUs. CONCLUSION: DFU is relatively uncommon among diabetic patients attending PHCs in Bahrain. Ischemic heart disease, foot skin changes, insulin use, and low hemoglobin were associated factors of DFU risk. Routine screening for these high-risk clinical features should be performed by physicians and nurses caring for patients with diabetes to reduce morbidity and prevent severe outcomes.