Digital Health and Community-Based Care for Diabetic Foot Prevention and Management in Resource-Limited Settings: A Narrative Review

Abstract

Abstract Diabetic foot disease is a major cause of preventable disability, hospitalization, and lower-extremity amputation worldwide, with a disproportionate burden in resource-limited settings. Although major amputation rates have declined in high-income countries through multidisciplinary care, many resource-limited settings still face delayed presentation, fragmented services, limited specialist access, and weak financial protection. Previous reviews have often examined diabetic foot care, digital health, or community interventions separately, with limited attention to how these approaches can be integrated in resource-limited settings and implemented through a health equity lens. This narrative review therefore aimed to examine, from a global health and health equity perspective, how digital health and community-based care may jointly support diabetic foot prevention and management in resource-limited settings, particularly in sub-Saharan Africa (SSA). A structured search of PubMed/MEDLINE, Web of Science, and Scopus, supplemented by relevant policy and guideline sources, identified evidence published between 2005 and 2025. Findings were synthesized across five domains: organized care in high-income settings, structural inequities in SSA, digital health approaches, community-based prevention and early referral, and system-level implementation considerations. Available evidence suggests that digital tools may improve risk identification and continuity of care, while community-based strategies may strengthen prevention and timely referral. However, their effectiveness and sustainability depend on integration with primary care, referral systems, workforce support, financing, and local adaptation. Digital and community-based approaches should therefore be viewed as complementary strategies for strengthening equitable diabetic foot care, rather than as stand-alone solutions. Graphical Abstract Flowchart of personalized risk assessment pathways in healthcare. Flowchart detailing personalized risk assessment in healthcare. Digital Healthcare includes Mobile Health, Data Platform, AI Analysis and Intelligence Alerts, leading to Personalized Risk Assessment. Community Education involves Community Engagement, Detection Monitoring, Improve Health Literacy and Self-Management Training, also leading to Personalized Risk Assessment. From there, two pathways emerge: Low-risk pathway with Routine Follow-up, Group Education, Maintain Stability and Prevent Ulcer Occurrence; and High-risk pathway with Regular Remote Consultation, Real-time Data Monitoring, Ulcer Remission and Emergency Limb Salvage. Both pathways lead to Government collaboration with Non-Government Organization, focusing on Policy and Governance, Financing and Resource Allocation, Workforce Capacity Building, Referral and Service Integration and Monitoring and Accountability. http://www.w3.org/1999/xlink print-only float portrait JMDH-19-620320-g0001.jpg anchor uf0001 portrait graphical