Social Deprivation and Incident Diabetes-Related Foot Disease in Patients With Type 2 Diabetes: A Population-Based Cohort Study

Abstract

To investigate the relationship between social deprivation and incident diabetesrelated foot disease (DFD) in newly diagnosed patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A population-based open retrospective cohort study using The Health ImprovementNetwork (1 January 2005 to 31 December 2019) was conducted. Patients with type 2 diabetes free of DFD at baseline were stratified by Townsend deprivation index, and risk of developing DFD was calculated. DFD was defined as a composite of foot ulcer (FU), Charcot arthropathy, lower-limb amputation (LLA), peripheral neuropathy (PN), peripheral vascular disease (PVD), and gangrene. RESULTSA total of 176,359 patients were eligible (56% men; mean age 62.9 [SD 13.1] years). After excluding 26,094 patients with DFD before/within 15 months of type 2 diabetes diagnosis, DFD incidentally developed in 12.1% of the study population over 3.27 years (interquartile range 1.41-5.96). Patients in the most deprived Townsend quintile had increased risk of DFD compared with those in the least deprived (adjusted hazard ratio [aHR] 1.22; 95% CI 1.16-1.29) after adjusting for sex, age at type 2 diabetes diagnosis, ethnicity, smoking, BMI, HbA 1c , cardiovascular disease, hypertension, retinopathy, estimated glomerular filtration rate, insulin, glucose/lipid-lowering medication, and baseline foot risk. Patients in the most deprived Townsend quintile had higher risk of PN

Diabetic Foot Risk Classification at the Time of Type 2 Diabetes Diagnosis and Subsequent Risk of Mortality: A Population-Based Cohort Study

“…In addition, the present study included those who declined a foot examination, and those who had no recording of a foot examination; both groups had a greater risk of death compared to those in the low DFD risk group. There was an increased rate of refusal of foot examination in more deprived groups, which may further contribute to health inequalities in this group, suggesting that specific strategies to engage more socially deprived groups after a diagnosis of type 2 diabetes are needed ( 24 ). Foot protection service, including assessing the biomechanical status of the feet and the vascular status of the lower limbs, and providing specialist footwear and orthoses, in those with elevated DFD risk at the time of diagnosis of type 2 diabetes may help prevent progression of DFD such as foot ulcer and limb amputation, reducing morbidity and the direct and indirect health costs for diabetes management ( 6 ).…”

“…The index date was defined as 15 months following the date of diagnosis of type 2 diabetes ( 24 ), which was chosen because of the requirement to measure foot risk soon after diagnosis of diabetes and reassess the risk annually as per NICE guidelines and Quality Outcomes Framework (QOF) in the UK ( 6 , 25 ). The QOF indicator is defined as the percentage of patients with diabetes with a record of a foot examination and risk classification within the preceding 15 months ( 25 ).…”

“…CVD was defined as atrial fibrillation (AF), heart failure, ischemic heart disease (IHD), and stroke and transient ischemic attacks (TIA). HbA1c was categorized as ≤47.5 mmol/mol, 47.5–58.5 mmol/mol, 58.5–69.4 mmol/mol, and >69.4 mmol/mol ( 24 ). Drugs included lipid drugs, metformin, insulin, and other diabetes drugs (glitazones, glinides, acarbose, glucagon-like peptide 1 [GLP-1] receptor agonists, dipeptidyl peptidase-4 [DPP-4] inhibitors, sodium-glucose co-transporter-2 [SGLT-2] inhibitors, and sulfonylureas).…”

Polycystic Ovary Syndrome, Combined Oral Contraceptives, and the Risk of Dysglycemia: A Population-Based Cohort Study With a Nested Pharmacoepidemiological Case-Control Study

“…Covariates include age, BMI, socioeconomic status, ethnicity, smoking status, and record of hypertension, hypothyroidism, and prescription of lipid-lowering medications. Socioeconomic status was presented with use of Townsend score ( 26 – 28 ). Ethnicity was categorized based on U.K. 2011 census classification.…”

The patient's perspective of diabetic foot ulceration: A phenomenological exploration of causes, detection and care seeking

“…Taken in concert with other frequent comorbidities, ulceration and amputation dramatically reduce life expectancy for people with diabetes (Gregg et al, 2016), and evidence from diverse countries and settings has shown that those who do survive endure an array of hardships that include impaired physical function, poor quality of life, economic stress, depression and emotional suffering (Crocker et al, 2021;Pedras et al, 2018). Of concern, these poor outcomes disproportionately burden racial and ethnic minority and socioeconomically disadvantaged populations (Riley et al, 2021;Tan et al, 2020).…”