Recommendations to Prevent Diabetic Foot Ulcer in Patients with Diabetes Mellitus During Hajj Pilgrimage

Hajj is one of the main pillars of Islam, and it is obligatory for all adult Muslims who can afford to travel and are in acceptable health. In this religious event, every year, about 2 to 3 million Muslim pilgrims of different nationalities gather in the city of Mecca, Kingdom of Saudi Arabia, and a large part of this population consists of older adults (25% over 65 years old) who are exposed to various chronic diseases such as diabetes. At least 5% of pilgrims have diabetes, and 13.8% have underlying diabetic neuropathy. Diabetic foot ulcer, a preventable complication of diabetes, is one of the most common reasons for visiting a doctor during Hajj, and if not treated, it leads to amputation and disability. It has profound consequences on the health system and society.On the other hand, many conditions affect pilgrims. Crowding, hot desert weather, physical activity in the open environment, neglecting self-management, changes in diet, and the existence of restrictions such as the prohibition of placing oneself in the shade can be examples of new conditions that increase the risk of diabetic foot ulcers. This article provides recommendations for preventing diabetic foot ulcers for patients with diabetes and their medical teams before and during this valuable spiritual pilgrimage.