SCIRP Review Highlights Winter Diabetic Foot Risks in J&K

Diabetic foot ulcers affect between 15% and 25% of people with diabetes during their lifetime, according to data synthesized by the International Working Group on the Diabetic Foot (IWGDF).

These complications precede more than 80% of diabetes-related lower-limb amputations, a statistic that carries heavy implications for regions facing extreme seasonal shifts. In Jammu and Kashmir, the intersection of rising diabetes prevalence and severe winter conditions creates a specific physiological vulnerability that standard tropical or temperate medical guidelines may not fully address.

A recent narrative review published by SCIRP highlights how the region’s unique environmental profile—characterized by the intense 40-day “Chillai Kalan” cold period—interacts with the biological realities of diabetes. The report suggests that for a population already facing rising glucose levels, the onset of winter introduces thermal, vascular, and neurological hazards that can accelerate the progression from minor injury to limb loss.

The stakes are not merely medical; they are deeply economic. For households in hilly or resource-constrained areas, the cost of managing a foot complication can escalate rapidly from simple ambulatory care to expensive surgical interventions.

Diabetes affects Jammu region with many cases undiagnosed

Data from the ICMR-INDIAB survey indicates 18.9% of the Jammu region has diabetes. This figure breaks down to 26.5% in urban areas and 14.5% in rural settings, while prediabetes affects another 10.8% of the population. Perhaps most concerning for public health planners is that roughly 40% of these cases remain undiagnosed.

Undiagnosed diabetes means that a large segment of the population is receiving no structured foot screening, glycemic counseling, or footwear advice. This lack of early intervention is particularly dangerous when seasonal changes occur, as patients may not realize they are at risk until a complication, such as an ulcer, has already manifested.

The NFHS-6 (2023-24) survey provides a broader view of the Union Territory, reporting elevated blood glucose—a screening measure rather than a clinical diagnosis—in 13% of women and 11.3% of men. These figures represent a notable increase from the NFHS-5 period (2019-21), where rates were 8.7% for women and 8% for men.

Care Pathway	Approximate Cost per Episode (USD)
Ambulatory care, uncomplicated neuropathic ulcer	~$56
Ambulatory care, infected neuropathic foot	~$165
Advanced diabetic foot (limb salvage)	~$1080
Limb amputation	~$960
Salvage followed by amputation	~$2650
Neuro-ischaemic foot requiring bypass	~$1960

As shown in the table above, the cost of care scales aggressively as the condition worsens. While an uncomplicated ulcer might cost roughly $56 to manage, a situation requiring limb salvage followed by amputation can reach as high as $2,650 per episode.

The physiological impact of winter cold

Winter weather does not just add discomfort; it actively interacts with the “classical triad” of diabetic foot risk: peripheral neuropathy, peripheral arterial disease, and foot deformity. When temperatures drop, the body triggers reflex peripheral vasoconstriction to protect core temperature. For a patient with existing peripheral arterial disease, this natural response can turn marginal blood flow into severe ischemia.

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Neuropathy further complicates this by removing the body’s primary warning system. Sensorimotor neuropathy can impair the ability to feel extreme temperatures, meaning a patient might not realize they are experiencing frostbite or thermal injury from traditional heating practices. This loss of the protective withdrawal response means that cold-induced injuries often go unnoticed until tissue damage is advanced.

A 2026 feasibility study using wearable sensors noted a statistically detectable drop in foot temperature during December, though the authors cautioned that this was observed in healthy volunteers and should not be interpreted as confirmed pathology in diabetic patients. However, the biological hypothesis remains that winter vasoconstriction reduces the “perfusion reserve” of the foot, making it less able to tolerate pressure or minor trauma than it would in the summer.

Structural hurdles in high-altitude healthcare

Beyond biological risks, the geography of Jammu and Kashmir presents logistical barriers to care. The region faces a shortage of podiatry and vascular-surgical expertise outside of major tertiary centers in Srinagar and Jammu. For rural populations, seasonal road closures during the harshest winter months can physically prevent patients from reaching specialized clinics.

This creates a dangerous cycle: patients in remote areas are more likely to have undiagnosed diabetes, more likely to face environmental triggers like extreme cold, and less likely to have timely access to the specialized care required to prevent an ulcer from becoming an amputation. The economic burden of these complications falls disproportionately on households that may lack the capacity to absorb such high medical expenditures.

While the national data for India shows that diabetes-related lower-limb amputation accounts for approximately 80% of all non-traumatic amputations, the specific registry data for Jammu and Kashmir is still lacking. This gap in local data makes it difficult to precisely quantify the regional burden, though the rising prevalence and severe climate suggest a growing public health challenge.