Knowledge, attitudes, and practices regarding diabetic foot care among patients with diabetes in China: a systematic review and meta-analysis.

BACKGROUND

Diabetic foot is a serious and largely preventable complication of diabetes. Patient knowledge, attitudes, and practices (KAP) regarding foot care are central to early prevention, yet the overall distribution of KAP levels among patients with diabetes in China remains unclear. This systematic review and meta-analysis aimed to estimate the pooled proportions of different levels of diabetic foot care-related KAP among patients with diabetes in China.

METHODS

The review was registered in PROSPERO (CRD420261328954) and followed PRISMA 2020 reporting guidance. PubMed, Embase, Scopus, the Cochrane Library, Web of Science, CINAHL Complete, SinoMed, CNKI, Wanfang, and VIP were searched from inception to March 2, 2026. Cross-sectional studies reporting extractable diabetic foot-care KAP data among Chinese adults with diabetes were included. Study quality was assessed using the 11-item Agency for Healthcare Research and Quality checklist. Random-effects proportion meta-analyses used the Freeman-Tukey double arcsine transformation. Subgroup, sensitivity, and small-study effect analyses were conducted where data allowed.

RESULTS

Twenty-four cross-sectional studies involving 6,124 participants across 13 Chinese provinces or municipalities were included. Fourteen studies contributed to the meta-analysis of knowledge, five to attitudes, and seventeen to practices. The pooled proportions of poor, satisfactory, and good knowledge were 33% (95% CI: 19-48%), 43% (95% CI: 33-54%), and 26% (95% CI: 17-37%), respectively. For attitudes, 33% (95% CI: 10-62%) of participants had unfavorable attitudes and 67% (95% CI: 38-90%) had favorable attitudes. For practices, the pooled proportions of poor, satisfactory, and good foot care practices were 45% (95% CI: 35-55%), 45% (95% CI: 38-53%), and 10% (95% CI: 6-14%), respectively. Substantial heterogeneity was observed across most outcomes, and subgroup analyses did not identify statistically significant differences by study region, diabetic foot status, or publication period.

CONCLUSION

Chinese patients with diabetes generally showed favorable attitudes toward diabetic foot care, but knowledge remained insufficient and good foot-care practices were uncommon. Because all included studies were cross-sectional, the pooled estimates primarily characterize the distribution of KAP levels and should be interpreted descriptively. When considered alongside existing guidelines and intervention evidence, these findings may inform the development of risk-stratified, behavior-oriented, and system-supported strategies for diabetic foot prevention.

SYSTEMATIC REVIEW REGISTRATION: Publicly accessible record: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261328954. PROSPERO registration: CRD420261328954.