Incidence and predictors of recurrent and other new diabetic foot ulcers: a retrospective cohort study

Abstract

Aims To estimate progression rates, evaluate risk factors for progression, and study rate ratios for progression among people with a healed diabetic foot ulcer according to whether the healed ulcer was neuropathic, neuro‐ischaemic or critically ischaemic. Methods We conducted a retrospective cohort study in all individuals with a healed diabetic foot ulcer treated at the Steno Diabetes Centre Copenhagen foot clinic in the period 2010 to 2016. The outcome of interest was recurrent/other new diabetic foot ulcers. Results A total of 780 people had a healed diabetic foot ulcer in the study period (2010–2016). The participants were followed for 1249 person‐years [median (Q1–Q3) 1.04 (0.38–2.46) person‐years] in total. One‐third (33.1%) developed a recurrent/other new diabetic foot ulcer per year. Male gender, people with Type 2 diabetes and smokers had a statistically significantly higher risk of progression to a recurrent/other new diabetic foot ulcer compared to participants without these risk factors. Participants with neuro‐ischaemic or critically ischaemic diabetic foot ulcers had statistically significantly higher progression rates than participants with neuropathic diabetic foot ulcers. Conclusions Focus should be on preventing future recurrent/other new diabetic foot ulcers especially in people with ischaemia.

Cumulative long-term recurrence of diabetic foot ulcers in two cohorts from centres in Germany and the Czech Republic

“…In contrast, ulcers reoccurred later in 60-75-year-old patients with T2DM than in those aged <60 at baseline. This finding, which confirms a study by Hicks et al [26], might be explained by the better ambulatory status and higher levels of activity in the younger populations.…”

“…Lower risk might be explained by greater attention of patients and health-care providers leading to an earlier detection of minor lesions -the strongest predictor for ulcer recurrence in patients with known risk but without postoperative foot deformities [31]. This assumption is supported by previous findings from our centre and observations from a recent US study showing shorter delay of presentation, higher proportions of non-operative management and shorter time to healing for recurrent episodes compared with the initial ulcer [26,32]. This indicates that after the second or further recurrent ulcers the risk of yet another recurrence tends to increase.…”

“…Looking only at studies from which raw data are available, the non-recurrence probability at one year is 0.74 and 0.70, translating to 26% and 30% recurrence (personal communication S. Bus and B. Petersen) [3,24]. Moreover, two recent studies which enrolled their patients immediately upon healing their index ulcer, report one year incidences almost identical to ours [25,26]. The effect described above attenuates when comparing the 5-year incidence in our study with the available literature [1,8,10].…”

Prevalence and risk factors of chronic wounds in nursing homes in Germany

“…The male gender was confirmed as a risk factor in the meta-analyses of Zhang, Lu 32 and Huang, Li. 33 In the study by Engberg, Kirketerp-Moller, 34 men also had a significantly higher risk of DFU. Different psychological and physiological states and anatomical structures, health behaviour, environmental experiences, reactions to stress events, and differences in risk behaviour can cause these differences.…”

Research on lower extremity health in patients with multiple sclerosis: a systematic scoping review

“…Lower extremity health and the related problems have been considered in many patient groups with long-term health conditions such as diabetes, [ 26 , 27 ] rheumatoid arthritis [ 28 ] and lupus [ 29 ]. For example, patients living with diabetes have an increased risk of developing foot problems such as neuropathic ulcers [ 30 ]; therefore, the number of foot problems in diabetic patients is higher than in the general population [ 31 ].…”