Mortality in 98 type 1 diabetes mellitus and type 2 diabetes mellitus: Foot ulcer location is an independent risk determinant

Abstract

Introduction:We previously demonstrated in both a longitudinal study and in metaanalysis (pooled relative-risk RR, 2.45) that all-cause mortality is significantly higher in people with diabetes foot ulceration (DFU) than with those without a foot ulcer. In this prospective study, we looked at the factors linked to mortality after presentation to podiatry with DFU. Methods: Ninety-eight individuals recruited consecutively from the Salford Royal Hospital Multidisciplinary Foot Clinic in Spring 2016 were followed up for up to 48 months. Data concerning health outcomes were extracted from the electronic patient record (EPR). Results: Seventeen people (17) had type 1 diabetes mellitus, and 81 had type 2 diabetes mellitus. Thirty-one were women. The mean age (range) was 63.6 (28-90) years with maximum diabetes duration 45 years. Mean HbA1c was 72 (95% CI: 67-77) mmol/mol; 97% had neuropathy (International Working Group on the Diabetic Foot (IWGDF) monofilament); 62% had vascular insufficiency (Doppler studies); 69% of ulcers were forefoot, and 23% of ulcers were hind foot in location.Forty of 98 (40%) patients died in follow-up with 27% of death certificates including sepsis (not foot-related) and 35% renal failure as cause of death. Multivariate regression analysis indicated a 6.3 (95% CI: 3.9-8.1) fold increased risk of death with hind foot ulcer, independent of age/BMI/gender/HbA1c/eGFR/total cholesterol level. Conclusion: This prospective study has indicated a very high long-term mortality rate in individuals with DFU, greater for those with a hind foot ulcer and shown a close relation between risk of sepsis/renal failure and DFU mortality, highlighting again the importance of addressing all risk factors as soon as people present with a foot ulcer.

Impact of acute hyperglycemic crisis episode on survival in individuals with diabetic foot ulcer using a machine learning approach

“…Previous studies have reported that renal failure is closely associated with DFU mortality ( 25 ). Notably, A prospective study showed that 40% of patients died during the follow-up period, 35% of those due to renal failure ( 33 ). In our study, a total of 7 cases died from CKD with hemodialysis, which similarly suggested that CKD contributed much to mortality of DFUs patients.…”

Inforatio technique to promote wound healing of diabetic foot ulcers: study protocol for a parallel-group, evaluator-blinded, randomised clinical trial

“…The mid-trial visits are missed if the following cannot be fulfilled: (1) The visit is within a window of ±7 days; and (2) The visit is minimum 2 weeks after the previous trial visit. The window for the 20-week visit is from 20 weeks to 22 weeks and 4 days after baseline.…”

“…Chronic foot ulcers affect the quality of life of people with diabetes widely and is associated with increased mortality and morbidity. [1][2][3][4][5] Of people with diabetes 15%-25% develop chronic foot ulcers during their lifetime, 50%-60% of diabetic foot ulcers (DFUs) become infected and 20% of patients with infected DFUs undergo lower extremity amputations. 2 3 6 The treatment of these hard-to-heal ulcers is challenging.…”

Keeping score

“…In the first, 98 people with diabetes and active foot ulceration were followed up over 2 years. 1 Forty percent of the cohort died during follow-up, emphasising the enormous mortality of foot ulceration for people with diabetes. This alone is a striking and sobering finding but the authors also report that hindfoot ulceration has a sixfold greater risk of death compared with forefoot, independent of other factors, and the type of ulcer (ischaemic, neuropathic or both) had no impact on mortality.…”

“…In the first, 98 people with diabetes and active foot ulceration were followed up over 2 years 1 . Forty percent of the cohort died during follow‐up, emphasising the enormous mortality of foot ulceration for people with diabetes.…”