Insulin resistance, calluses and nail disease are among the factors independently linked to diabetic foot risk in Karachi, including ulceration, among people with type 2 diabetes, according to a study published in BMC Endocrine Disorders on 16 September. Almost three in ten patients attending two specialist foot clinics already had established foot risk factors, and one in six had an active ulcer.
What the study did
Nousheen Riaz of the Tabba Heart Institute and the Aga Khan Health Services diabetic foot clinic, with Ghazala Yasmeen of the University of Karachi and Moiz Ahmed Khan of the Tabba Heart Institute, examined 462 adults with type 2 diabetes at diabetic foot clinics at the Aga Khan Health Service Centre and the Tabba Heart Institute between January and June 2025.
Each patient had a clinical foot examination, 10-g monofilament testing for neuropathy, an ankle-brachial index measurement for peripheral arterial disease and fasting blood tests to calculate HOMA-IR, a measure of insulin resistance. Patients were grouped as no risk, at risk (neuropathy, impaired arterial supply or foot deformity) or active ulcer.
Key findings on diabetic foot risk in Karachi
- 28.9% of patients had established foot risk factors and 16.6% had an active diabetic foot ulcer.
- In unadjusted analysis, older age, higher BMI, higher diastolic blood pressure, smoking, previous ulceration or amputation, dry skin, hyperkeratotic lesions, fissures and nail deformities were all associated with risk or ulceration.
- After adjustment, the independent factors were insulin resistance (HOMA-IR), callus, corn or fissure formation, nail deformity, onychomycosis, daily foot inspection behaviour and a history of amputation.
The study is cross-sectional and drawn from two specialist clinics, so it shows associations rather than cause and effect, and the findings may not apply to everyone with type 2 diabetes in Pakistan. The early version of the paper does not yet report effect sizes for each factor.
What the authors recommend
To reduce diabetic foot risk in Karachi and beyond, the authors call for systematic foot surveillance, patient education and early intervention aimed at modifiable metabolic and dermatological precursors of ulceration.
IMEA POD Perspective
Most of the independent factors behind diabetic foot risk in Karachi are things a podiatrist sees at every appointment: callus, corns, fissures, thickened or deformed nails and fungal infection. Reducing callus lowers plantar pressure, and treating fissures and onychomycosis closes routes for infection, so routine skin and nail care is ulcer prevention, not cosmetic work. Pakistan has very few podiatrists, so in practice these tasks fall to nurses, diabetes educators and general practitioners. Short, practical training in callus and nail care, footwear checks and teaching patients to inspect their own feet could be built into existing diabetes clinics. The link with insulin resistance is a reminder that metabolic control and foot protection belong in the same consultation. Pakistan has recently added a 24-hour diabetic foot helpline and footcare in 171 rural health centres, and resistant infections make preventing ulcers in the first place all the more important.
Sources and further reading
- Riaz N, Yasmeen G, Khan MA. Prevalence and factors associated with diabetic foot complications among type 2 diabetes patients in Pakistan: a cross-sectional analysis of clinical risk factors and preventive opportunities. BMC Endocrine Disorders, 2026
- Bioengineer: Insulin resistance and foot damage drive diabetic ulcer risk in Pakistan
- IMEA POD: Diabetic foot infections in Khyber Pakhtunkhwa show high antibiotic resistance
- IMEA POD: Pakistan gets 24-hour diabetic foot helpline