Foot Ulcers in Type 1 and Type 2 Diabetes: What Research Shows About Risk and Healing

Diabetic foot ulcers are a serious health concern affecting millions of people worldwide. They can lead to infection, hospitalization, and in severe cases, amputation. Yet most medical research doesn't clearly separate how these ulcers develop differently—or similarly—in people with Type 1 versus Type 2 diabetes.

A new narrative review published in Science Progress examined this gap by looking at decades of published research on foot ulcer prevalence, healing times, recurrence rates, and outcomes across both diabetes types. The goal: to understand whether Type 1 and Type 2 diabetes create different risks and whether treatment approaches should differ.

The research reveals an important distinction between two ways of measuring foot ulcer risk. Population surveys suggest people with Type 1 diabetes face a higher lifetime prevalence—meaning more people will experience at least one foot ulcer over their lives. This appears driven primarily by disease duration: people living with Type 1 diabetes for 30 or 40 years have more time for complications to develop.

However, studies using medical registries and databases typically report higher annual incidence rates in Type 2 diabetes. This reflects that Type 2 most commonly affects older adults and those with additional health conditions like heart disease and poor circulation—factors that increase ulcer risk regardless of diabetes type.

One of the most clinically useful findings: healing time does not appear to differ substantially between people with Type 1 and Type 2 diabetes. Instead, the speed of healing depends far more on local wound characteristics—how deep the ulcer is, whether it's infected, and the surrounding tissue condition—and on vascular status, meaning how well blood can reach the wound.

This suggests that diabetes type itself may be less important than these other factors when predicting whether an ulcer will heal quickly or slowly.

One challenge spans both diabetes types: recurrence. Even after a foot ulcer heals completely, many people develop new ulcers later. The review found this remains frequent and a persistent clinical concern for both groups, though people with Type 2 diabetes may experience a greater burden of repeat ulcers.

The authors emphasize an important caution: most studies in this area lack the rigorous statistical methods needed to prove whether diabetes type truly drives different outcomes. When studies find no clear difference between groups, that doesn't necessarily mean the groups are truly equivalent—it may simply mean the research design wasn't powerful enough to detect a real difference.

Both Type 1 and Type 2 diabetes increase amputation risk, but the magnitude varies across different populations and study types. Future research using stronger methods could clarify whether and how diabetes type itself influences foot ulcer outcomes, helping clinicians tailor prevention and treatment strategies more precisely.

Source: Science progress. Evidence type: PubMed indexed literature. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.