{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T22:30:14Z","timestamp":1792449014194,"version":"4.5.0"},"reference-count":34,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"unspecified","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,7]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the early risk of diabetic foot ulcer (DFU) among adult patients with diabetes and to identify clinical and behavioural correlates associated with DFU risk using Inlow\u2019s 60-Second Screening Tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional analytical study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Conducted at a tertiary-level referral hospital in Southwest Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The study included 164 adult patients with diabetes (aged \u226518 years) who attended routine follow-up visits at the diabetic clinic between February and March 2025. Patients who were critically ill, unable to communicate during data collection or pregnant were excluded. The median age of participants was 55 years (IQR 46\u201360), and 54.9% were male.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was early DFU risk, categorised as \u2018at risk\u2019 or \u2018not at risk\u2019 using Inlow\u2019s 60-Second Screening Tool. Secondary outcomes included factors associated with DFU risk, such as glycaemic control, lipid profile and foot care practices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 164 participants, 32.3% (n=53) were found to be at risk for DFU. Participants who performed foot self-checks infrequently had more than threefold higher odds of DFU risk compared with those who practiced daily foot care (adjusted OR (AOR)=3.35; 95% CI 1.48 to 7.58; p=0.004). Poor glycaemic control (AOR=2.39; 95%\u2009CI 1.03 to 5.55; p=0.042) and dyslipidaemia (AOR=2.63; 95%\u2009CI 1.18 to 5.85; p=0.018) were also significantly associated with increased DFU risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nearly one-third of patients with diabetes in this Ethiopian hospital setting were at early risk for DFU. Factors such as inadequate foot care, poor glycaemic control and dyslipidaemia were associated with increased risk. Incorporating rapid foot screening tools like Inlow\u2019s 60-Second assessment into routine diabetes care, together with strengthened patient education and metabolic management, may help reduce the risk of DFU in resource-limited settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-109514","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T18:40:37Z","timestamp":1764355237000},"page":"e109514","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical and behavioural correlates of early diabetic foot ulcer risk at Jimma Medical Center, Ethiopia: application of Inlow\u2019s 60-Second Screening Tool in a resource-constrained setting"],"prefix":"10.1136","volume":"15","author":[{"given":"Tekleab","family":"Kifle","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Jimma University, Jimma, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9030-4328","authenticated-orcid":false,"given":"Eyob Girma","family":"Abera","sequence":"additional","affiliation":[{"name":"Department of Public Health, Jimma University, Jimma, Ethiopia"},{"name":"Jimma University Clinical Trial Unit, Jimma, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kidus","family":"Tesfaye","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Jimma University, Jimma, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ermias Habte","family":"Gebremichael","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Jimma University, Jimma, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esayas Kebede","family":"Gudina","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Jimma University, Jimma, Ethiopia"},{"name":"Jimma University Clinical Trial Unit, Jimma, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"2025112810401999000_15.11.e109514.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0290240","article-title":"The magnitude of chronic diabetes complications and its associated factors among diabetic patients attending the general hospitals in Tigray region, Northern Ethiopia","volume":"18","author":"Berhe","year":"2023","journal-title":"PLoS One"},{"key":"2025112810401999000_15.11.e109514.2","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.4239\/wjd.v13.i12.1106","article-title":"Diabetic foot ulcers: A devastating complication of diabetes mellitus continues non-stop in spite of new medical treatment modalities","volume":"13","author":"Akkus","year":"2022","journal-title":"World J Diabetes"},{"key":"2025112810401999000_15.11.e109514.3","doi-asserted-by":"crossref","first-page":"209","DOI":"10.2337\/dci22-0043","article-title":"Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers","volume":"46","author":"McDermott","year":"2023","journal-title":"Diabetes Care"},{"key":"2025112810401999000_15.11.e109514.4","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12404"},{"key":"2025112810401999000_15.11.e109514.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-019-8133-y","article-title":"Prevalence and associated factors of foot ulcer among diabetic patients in Ethiopia: a systematic review and meta-analysis","volume":"20","author":"Tolossa","year":"2020","journal-title":"BMC Public Health"},{"key":"2025112810401999000_15.11.e109514.6","article-title":"Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic Patients on Follow-Up Clinic at Jimma Medical Center, Southwest Ethiopia, 2019: An Institutional-Based Cross-Sectional Study","volume":"2020","author":"Abdissa","year":"2020","journal-title":"J Diabetes Res"},{"key":"2025112810401999000_15.11.e109514.7","unstructured":"Harrison TR . Principles of internal medicine. In: Principles of internal medicine. 1954;1703."},{"key":"2025112810401999000_15.11.e109514.8","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.4239\/wjd.v13.i12.1049","article-title":"Diabetic foot ulcers: Classification, risk factors and management","volume":"13","author":"Wang","year":"2022","journal-title":"World J Diabetes"},{"key":"2025112810401999000_15.11.e109514.9","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/01.ASW.0000415343.45178.91","article-title":"Reliability and predictive validity of Inlow\u2019s 60-Second Diabetic Foot Screen Tool","volume":"25","author":"Murphy","year":"2012","journal-title":"Adv Skin Wound Care"},{"key":"2025112810401999000_15.11.e109514.10","unstructured":"Reddie M . Redesigning diabetic foot risk assessment for amputation prevention in low-resource settings: development of a purely mechanical plantar pressure evaluation device. Massachusetts Institute of Technology, 2023."},{"key":"2025112810401999000_15.11.e109514.11","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.23.7.943"},{"key":"2025112810401999000_15.11.e109514.12","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1002\/pdi.1099","article-title":"Validation of a new measure of protective footcare behaviour: the Nottingham Assessment of Functional Footcare (NAFF)","volume":"24","author":"Lincoln","year":"2007","journal-title":"Pract Diab Int"},{"key":"2025112810401999000_15.11.e109514.13","first-page":"72","article-title":"Screening for the high-risk diabetic foot: a 60-second tool (2012)\u00a9: diabetes","volume":"5","author":"Sibbald","year":"2012","journal-title":"Wound Heal South Africa"},{"key":"2025112810401999000_15.11.e109514.14","doi-asserted-by":"crossref","first-page":"3000605221087815","DOI":"10.1177\/03000605221087815","article-title":"Screening for identification of patients at high risk for diabetes-related foot ulcers: a cross-sectional study","volume":"50","author":"Al-Mohaithef","year":"2022","journal-title":"J Int Med Res"},{"key":"2025112810401999000_15.11.e109514.15","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-034058","article-title":"Risk of diabetic foot ulcer and its associated factors among Bangladeshi subjects: a multicentric cross-sectional study","volume":"10","author":"Banik","year":"2020","journal-title":"BMJ Open"},{"key":"2025112810401999000_15.11.e109514.16","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001814","article-title":"The Guyana Diabetes and Foot Care Project: a complex quality improvement intervention to decrease diabetes-related major lower extremity amputations and improve diabetes care in a lower-middle-income country","volume":"12","author":"Lowe","year":"2015","journal-title":"PLoS Med"},{"key":"2025112810401999000_15.11.e109514.17","doi-asserted-by":"crossref","DOI":"10.4103\/jehp.jehp_407_20","article-title":"Assessment of diabetic foot risk among diabetic patients in a tertiary care hospital, South India","volume":"10","author":"Akila","year":"2021","journal-title":"J Educ Health Promot"},{"key":"2025112810401999000_15.11.e109514.18","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1111\/dme.13837","article-title":"Developing a foot ulcer risk model: what is needed to do this in a real-world primary care setting?","volume":"36","author":"Heald","year":"2019","journal-title":"Diabet Med"},{"key":"2025112810401999000_15.11.e109514.19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2337\/db20182-1","article-title":"Diagnosis and Management of Diabetic Foot Complications","volume":"2018","author":"Boulton","year":"2018","journal-title":"Compendia"},{"key":"2025112810401999000_15.11.e109514.20","doi-asserted-by":"crossref","DOI":"10.1002\/dmrr.3269","article-title":"Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)","volume":"36 Suppl 1","author":"Bus","year":"2020","journal-title":"Diabetes Metab Res Rev"},{"key":"2025112810401999000_15.11.e109514.21","doi-asserted-by":"crossref","first-page":"39","DOI":"10.20473\/jn.v19i1.48387","article-title":"Self-care of chronic illness prevents the risk of diabetic foot ulcers in patients with diabetes: a cross-sectional study","volume":"19","author":"Joeliantina","year":"2024","journal-title":"J Ners"},{"key":"2025112810401999000_15.11.e109514.22","first-page":"264","article-title":"Prevalence and factors associated with suboptimal foot self-care practices among adult diabetic patients in governmental hospitals in Hawassa city, Sidama Region, Ethiopia: A cross-sectional study","volume":"3","author":"Berisso","year":"2023","journal-title":"Ethiop J Med Heal Sci"},{"key":"2025112810401999000_15.11.e109514.23","doi-asserted-by":"crossref","first-page":"3739","DOI":"10.2147\/DMSO.S265988","article-title":"Determinants of Diabetic Foot Ulcer Among Adult Patients with Diabetes Attending the Diabetic Clinic in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: Unmatched Case-Control Study","volume":"13","author":"Woldemariam","year":"2020","journal-title":"Diabetes Metab Syndr Obes"},{"key":"2025112810401999000_15.11.e109514.24","first-page":"142","article-title":"Relationship between self-care level and risk of diabetic foot ulcers (DFU) in diabetes mellitus patients","volume":"8","author":"Basri","year":"2025","journal-title":"InternatJrnl"},{"key":"2025112810401999000_15.11.e109514.25","doi-asserted-by":"crossref","unstructured":"Schaper NC , van Netten JJ , Apelqvist J , et al . Practical guidelines on the prevention and management of diabetes\u2010related foot disease (IWGDF 2023 update). Diabetes Metabolism Res 2024;40. doi:10.1002\/dmrr.3657","DOI":"10.1002\/dmrr.3657"},{"key":"2025112810401999000_15.11.e109514.26","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1111\/iwj.13010","article-title":"Perceptions and experiences of diabetic foot ulceration and foot care in people with diabetes: A qualitative meta-synthesis","volume":"16","author":"Coffey","year":"2019","journal-title":"Int Wound J"},{"key":"2025112810401999000_15.11.e109514.27","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.18203\/2349-2902.isj20232637","article-title":"Correlation of glycated haemoglobin status with the foot ulcer","volume":"10","author":"Sachar","year":"2023","journal-title":"Int Surg J"},{"key":"2025112810401999000_15.11.e109514.28","doi-asserted-by":"crossref","DOI":"10.1155\/jdr\/4744194","article-title":"HbA1c and the Risk of Lower Limb Ulcers Among Diabetic Patients: An Observational and Genetics Study","volume":"2025","author":"Guo","year":"2025","journal-title":"J Diabetes Res"},{"key":"2025112810401999000_15.11.e109514.29","doi-asserted-by":"crossref","first-page":"107638","DOI":"10.1016\/j.jdiacomp.2020.107638","article-title":"Glycemic control and diabetic foot ulcer outcomes: A systematic review and meta-analysis of observational studies","volume":"34","author":"Lane","year":"2020","journal-title":"J Diabetes Complications"},{"key":"2025112810401999000_15.11.e109514.30","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.2.217"},{"key":"2025112810401999000_15.11.e109514.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2013.03.007"},{"key":"2025112810401999000_15.11.e109514.32","doi-asserted-by":"crossref","unstructured":"Yachmaneni A , Jajoo S , Mahakalkar C , et al . A Comprehensive Review of the Vascular Consequences of Diabetes in the Lower Extremities: Current Approaches to Management and Evaluation of Clinical Outcomes. Cureus 2023;15. doi:10.7759\/cureus.47525","DOI":"10.7759\/cureus.47525"},{"key":"2025112810401999000_15.11.e109514.33","doi-asserted-by":"crossref","first-page":"3043","DOI":"10.2147\/DMSO.S461330","article-title":"Trajectories of Remnant Cholesterol are Associated with Diabetic Foot Ulcer in Adult Patients with Type 2 Diabetes: A Retrospective Cohort Study","volume":"17","author":"Cao","year":"2024","journal-title":"Diabetes Metab Syndr Obes"},{"key":"2025112810401999000_15.11.e109514.34","first-page":"9554","article-title":"Risk factors of diabetic foot ulcer in patients with type 2 diabetes: a retrospective cohort study","volume":"13","author":"Ouyang","year":"2021","journal-title":"Am J Transl Res"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-109514","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T18:40:40Z","timestamp":1764355240000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-109514"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":34,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,28]]},"published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1136\/bmjopen-2025-109514"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-109514","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]}}}