Preventive strategies for diabetic foot ulcer recurrence: a systematic review and meta-analysis of randomized controlled trials

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INTRODUCTION: Diabetic foot syndrome (DFS) is among the most disabling complications of diabetes mellitus and is associated with substantial healthcare utilization and impaired quality of life. Despite successful ulcer healing, recurrence remains frequent, underscoring the importance of secondary preventive strategies. The aim of this study was to systematically review and quantitatively synthesize evidence from randomized controlled trials (RCTs) assessing interventions designed to prevent recurrence of diabetic foot ulcers (DFUs).EVIDENCE ACQUISITION: A systematic search identified RCTs investigating preventive interventions, including treatment of pre-ulcerative lesions, surgical procedures, structured educational programs, foot self-management strategies, and physical exercise. When appropriate, pooled relative risks (RRs) with corresponding 95% confidence intervals (CIs) were calculated. Among 285 screened records, nine RCTs fulfilled eligibility criteria.EVIDENCE SYNTHESIS: Interventions targeting pre-ulcerative lesions did not demonstrate a significant overall effect on recurrence prevention (RR 0.87 [95% CI 0.29-3.50] I2=84.1%). In contrast, more intensive clinical follow-up at 4-week intervals was associated with a significantly lower recurrence rate compared with longer surveillance intervals (RR 0.44 [95% CI 0.24-0.84]). Structured foot-care education programs markedly reduced recurrence risk (RR 0.22 [95% CI 0.09-0.56]), whereas isolated self-management approaches and physical exercise interventions did not show statistically significant benefits.CONCLUSIONS: Prevention of DFU recurrence remains challenging. Structured educational interventions and frequent clinical surveillance appear most effective, while isolated clinical or self-care strategies have limited impact. Integrating intensive follow-up and patient education may substantially improve long-term outcomes in high-risk diabetic populations.

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