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09-12-2021 | Diabetes | News | Article

Foot ulceration associated with increased risk for amputation or death

Alba Ruzafa

medwireNews: Study results suggest that among people with diabetes, those with a history of foot ulceration are more likely to undergo amputation or die than those without.

Using the Scottish Care Information – Diabetes database, Graham Leese (Ninewells Hospital, Dundee, UK) and co-authors observed that out of 23,395 individuals with type 1 diabetes and 210,064 with type 2 diabetes included in the study, a total of 13,093 had a previous foot ulceration and among these, 34.3% developed a further foot ulcer during the follow‑up period (2012–2017). In addition, a total of 9023 people developed a first ulcer during follow-up.

The researchers report that the overall incidence of a new or recurrent ulcer was 11.2 per 1000 person–years, with a rate of recurrent ulceration of 97 per 1000 person–years and an incidence of first-time foot ulcers of 7.8 per 1000 person–years.

During a maximum 6 years of follow-up, 21.7% of the study population had an amputation or died, with higher rates of these outcomes among people with a history of ulceration than those without. Among 6482 events occurring in people with a prior ulcer (49.5% of the population), 5820 were deaths and 1228 were amputations. In people without a history of ulcers, there were 44,214 events of which 43,175 were deaths and 1638 amputations.

The researchers identified a number of baseline risk factors linked to increased rates of amputation-free survival, including older age, social deprivation, mental illness, and male sex, as well as conventional cardiovascular risk factors such as smoking and hypertension. In particular, people in the most deprived quintile for socioeconomic status had a higher crude risk for amputation or death (1.9-fold higher for type 1 diabetes and 1.2-fold higher for type 2 diabetes) compared with those in the least deprived quintile. People with mental illness also had a higher crude risk for death or amputation (1.7-fold higher for those with type 1 diabetes and 1.1-fold higher for type 2 diabetes) than people without mental illness.

In a multivariable analysis, the team found that foot ulcers were associated with a significant 2.09-fold increased risk for amputation or death in people with type 1 diabetes, and a significant 1.65-fold increased risk in those with type 2 diabetes, after adjustment for a range of confounding factors.

These results “demonstrated a strong association between a history of foot ulcer and amputation or death,” which can be considered “a potential measure of effectiveness of care among people with diabetes,” write Leese et al in Diabetes Care.

Leese and co-workers conclude that factors such as social deprivation and mental illness must be addressed “in order to reduce premature mortality and amputations for people with diabetes and foot ulcers.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

Diabetes Care 2021; doi:10.2337/dc21-1596

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