Tropical diabetic hand syndrome (TDHS) is one of the diabetic hand infections which can recover without sequelae, but it may also result in loss of hand function, amputation, or death.7-10,13,14 Risk factors of TDHS include poor blood glucose regulation, neuropathy, insulin therapy, and malnutrition.7 Even though diabetic hand was defined in tropical regions, it may also be seen in western countries.11,12 Our data indicated that diabetic hand infections were related to education status, awareness of the infection, and blood glucose control rather than climate or geography. This evidence concerns the gene INS and malnutrition.