Diabetic foot ulcer research activity (2004–2020)

The paper I have chosen for this commentary is not a clinical research paper, but hopefully one that will stimulate everyone whether from a clinical, educational, managerial or industry-based workplaces. It is from China, reviewing the global trends for research activity and hotspots in diabetic foot ulceration (DFU). It examined the DFU research activity using the Science Citation Index Expanded (SCI-expanded) of Web of Science Core Collection (WoSCC) using key words, such as ‘diabetic foot ulcer’ or ‘diabetic foot wound’. This database was used as it was deemed to cover most of the high impact and quality international scientific journals. The information of all identified publications included title, year of publication, author, affiliations, nationalities, journal, abstract and keywords. A total of 5,869 publications on DFUs were identified covering a 17-year period (2004 to 2020), which was divided into three equal time intervals: 2004–2009, 2010–2015 and 2016–2020. There were 4,500 research and 865 review articles from a total of 100 countries. Three-quarters of these publications came from eight countries, with the US publishing the most papers, followed by China, England, Germany, Italy, France, Canada and Sweden. Among them, the US contributed to the most publications (n=1,866), followed by England (n=606), China (n=599), and Germany (n=336). The highest citation rates were USA (n=50,308), UK (n=16,967), Netherlands (7,101), China (7,001) and Germany (5,871). Diabetes Care was the cited journal, suggesting it may be the key quality journal. There was a slow but significant publication increase from 119 (2004) to 355 (2015) with a greater increase thereafter but a sharp increase from 562 (2019) to 703 (2020). The top three authors were David Armstrong (US) with 91 papers, Lawrence Lavery (US) with 55 papers and Sicco Bus (Netherlands)with 46 papers. The University of Washington (USA) had the greatest number of publications with 103 papers, followed by the University of Manchester (UK) with 94 papers and the University of Miami (USA) with 92 papers. Perhaps an important feature of this paper is that it suggests five potential future research areas from the keyword co-occurrence relationship analysis: rehabilitation study, surgery, complications, molecular mechanisms and clinical studies. Obviously, this paper only reflects DFU publications and perhaps gives a glimpse of an encouraging and increasing trend for ongoing research in this, and perhaps other, diabetic foot research. It also highlights the need for a sustained growth in our knowledge and understanding of this challenging and increasing clinical area. I hope this encourages individuals, institutions and industry to increase support and facilitate research in the diabetic foot.