By Colin Kenny, Editor – Diabetes Distilled
Investigators studied people living with diabetes with a high risk of foot ulceration (high-risk foot) but who were amputation-free and compared them with different subcategories of high-risk foot. They identified a large cohort of patients on the Scotland-wide diabetes register and calculated their amputation-free survival rates during the follow-up period. The risk of death was up to nine times the risk of amputation in individuals judged to have a high-risk foot. A higher percentage of people with healed ulcers died during the 2-year follow-up period than those with active ulcers. People with active ulcers had the highest risk of amputation.
Investigators wanted to discover what happened to a large cohort of people living with diabetes who were assessed as having ‘high-risk’ feet and who were amputation-free at baseline. They also compared outcomes for different categories of high-risk foot (no previous ulcer, having an active ulcer, or having a healed previous ulcer at baseline).
Investigators used the Scottish Care Information-Diabetes population-based database to identify people at high risk for foot ulceration based on SIGN Guideline 116 criteria (SIGN, 2010). A total of 17,353 people with diabetes with high-risk foot were included in the study. Of these, 13,206 (76.1%) had neither ulcers nor a history of previous ulceration at baseline.
The 2-year amputation-free survival rate in all people with high-risk foot was found to be 84.5%, with amputation-free survival being lower in the active ulcer group (81.6%) and the healed ulcer group (76.1%). People with diabetes and already-healed ulcers had a worse outcome than people with an active ulcer, who in turn had a worse outcome than people with diabetes and no previous foot ulcer. One in four people with a previously-healed ulcer died within 2 years, while the corresponding figure for people with no previous ulcer but with high-risk foot was one in eight. In conclusion, the risk of amputation was highest in people with active ulcers and the risk of death highest for people with healed ulcers.
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Scottish Intercollegiate Guidelines Network (2010) SIGN Guideline 116: Management of diabetes. https://www.sign.ac.uk/assets/sign116.pdf
