TITLE:
Prevention of Diabetic Foot Complications in Winter: Special Considerations for Jammu and Kashmir
AUTHORS:
Arshid Rafiq, Peerzada Umar Farooq Baba, Sulaiman Sath, Muzaffar Ahanger, Rutba Maqbool, Summairah Mushtaq
KEYWORDS:
Diabetic Foot, Frostbite, Kangri Ulcer and Ischaemia
JOURNAL NAME:
Open Journal of Endocrine and Metabolic Diseases,
Vol.16 No.11,
November
13,
2026
ABSTRACT: Background: Diabetes mellitus prevalence in Jammu and Kashmir has risen sharply. The ICMR-INDIAB survey found overall prevalence of 18.9% specifically in the Jammu region (not the Union Territory as a whole), while separate, Union Territory-wide NFHS-6 data show elevated blood glucose—not a clinical diagnosis of diabetes—in 11.3% - 13% of adults; both sources point to a large undiagnosed burden. Diabetic foot disease is among the most disabling complications of diabetes, and international evidence indicates that its risk intensifies in cold climates through mechanisms distinct from those emphasized in temperate or tropical guidelines. Objective: To synthesize the epidemiological, pathophysiological, and culturally specific literature on winter-related diabetic foot risk in Jammu and Kashmir, and to translate international prevention frameworks into regionally appropriate recommendations. Methods: A narrative review of peer-reviewed literature, international guideline documents (International Working Group on the Diabetic Foot, 2023), and regional epidemiological reports was conducted, focusing on diabetic peripheral neuropathy, peripheral arterial disease, frostbite, thermal burn injury (including the regionally described “kangri ulcer”), classification and staging of diabetic foot lesions, and seasonal variation in foot-related outcomes. Results: The Kashmiri winter compounds the classical triad of neuropathy, ischaemia, and impaired wound healing through cold-induced vasoconstriction, loss of protective sensation to both cold and heat, dry and fissured skin, restrictive footwear, and widespread traditional use of open-ember heating devices. A distinct chronic cutaneous entity, the kangri ulcer, is well described in regional dermatological literature and carries a recognised risk of malignant transformation over years of repeated exposure; this is mechanistically and clinically separate from the acute thermal burns that diabetic neuropathy also predisposes to, which instead carry an immediate risk of infection and limb loss. Health-system barriers, seasonal isolation, workforce shortages, and low awareness further delay presentation and worsen outcomes. Conclusion: A structured, evidence-based, and culturally sensitive prevention strategy, aligned with IWGDF 2023 guidance but adapted to local heating practices, terrain, and health-system access, and supported by telemedicine and community screening models already piloted elsewhere in India, could meaningfully reduce the winter-associated burden of diabetic foot disease in this high-risk, high-altitude population, pending region-specific prospective research to confirm the magnitude of the winter effect.