This study aimed to investigate the association between waist-to-height ratio (WHtR) and the risk of diabetic foot ulcer (DFU) as well as one-year mortality in patients with type 2 diabetes mellitus (T2DM).

A retrospective analysis was conducted on 13,159 T2DM patients from a single medical center between April 2004 and April 2025. Patients were categorized into tertiles based on WHtR values. The prevalence of DFU and one-year mortality were compared across WHtR groups. Kaplan-Meier survival analysis and multivariate Cox proportional hazards models were used to evaluate the association between WHtR and clinical outcomes. Subgroup analyses were performed to assess the consistency of WHtR's predictive value.

The overall prevalence of DFU was 8.5%. Patients in the highest WHtR tertile had a significantly higher prevalence of DFU (13.57% vs. 6.13% in the lowest tertile, P<0.001) and higher one-year mortality. After adjusting for confounding factors, elevated WHtR remained independently associated with an increased risk of DFU (HR: 2.706, 95% CI: 2.182–3.356, P<0.001) and one-year mortality. A positive linear relationship was observed between WHtR levels and the risk of DFU and mortality. Subgroup analyses confirmed the consistent predictive value of WHtR across most clinical populations.

WHtR is significantly associated with the risk of DFU and one-year mortality in T2DM patients. These findings suggest that WHtR may serve as a simple and effective prognostic indicator for identifying high-risk individuals and guiding early interventions to improve clinical outcomes.