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Four English and three Chinese electronic databases were searched for cohort and case\u2013control studies reporting risk factors for first\u2010ever DFU. Two researchers independently screened titles, abstracts and full text, extracted data and assessed the quality of included studies. Meta\u2010analyses were performed for risk factors reported in at least two studies, using unadjusted odds ratios and standardised mean differences for dichotomous and continuous variables. Of 6736 potential studies screened, 23 were included in the meta\u2010analysis and 24 in the systematic review. Twenty\u2010eight significant risk factors for first\u2010ever DFU were identified, including older age, obesity, male gender, unmarried status, alcohol consumption, current smoking, insufficient physical activity, longer diabetes duration, increased HbA1c, fasting plasma glucose, creatinine and triglyceride, decreased eGFR and high\u2010density lipoprotein, high vibration perception threshold, albuminuria, low ankle\u2010brachial pressure index ratio, cardiovascular, cerebrovascular and peripheral artery disease, retinopathy, nephropathy, neuropathy, myocardial infarction, foot deformity, skin dryness, insulin treatment and anti\u2010hypertensive treatment. This study provides the first comprehensive synthesis of risk factors for first\u2010ever DFU. Identifying high\u2010risk individuals based on these factors can enhance early intervention strategies, reducing the burden of DFU in diabetes management.<\/jats:p>","DOI":"10.1111\/iwj.70728","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T06:53:08Z","timestamp":1753253588000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Risk Factors for First\u2010Ever Diabetes\u2010Related Foot Ulcer: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6709-5962","authenticated-orcid":false,"given":"Tao","family":"Yan","sequence":"first","affiliation":[{"name":"Discipline of Podiatric Medicine, School of Health Sciences University of Galway  County Galway Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhang","family":"Dou","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery University of Galway  County Galway Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MacGilchrist","family":"Claire","sequence":"additional","affiliation":[{"name":"Discipline of Podiatric Medicine, School of Health Sciences University of Galway  County Galway Ireland"},{"name":"Alliance for Research and Innovation in Wounds, College of Medicine, Nursing &amp; Health Sciences University of Galway  County Galway Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirwan","family":"Ellen","sequence":"additional","affiliation":[{"name":"Discipline of Podiatric Medicine, School of Health Sciences University of Galway  County Galway Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"McIntosh","family":"Caroline","sequence":"additional","affiliation":[{"name":"Discipline of Podiatric Medicine, School of Health Sciences University of Galway  County Galway Ireland"},{"name":"Alliance for Research and Innovation in Wounds, College of Medicine, Nursing &amp; Health Sciences University of Galway  County Galway Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,22]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"IDF Diabetes Atlas","author":"IDF Diabetes Atlas 11th edition scientific committee","year":"2024"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2016.1231932"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.14840"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(05)67698\u20102"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13047\u2010020\u201000383\u20102"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc13\u20102176"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/1708538120923420"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.14017"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.13200"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2319"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/edm2.175"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.2018"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125\u2010010\u20101821\u2010x"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/0300060520987398"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3268"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654\u2010010\u20109491\u2010z"},{"key":"e_1_2_10_19_1","article-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.5 (Updated August 2024)","author":"Higgins J. 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