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Foot ulceration risk associated with mortality

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.

To access the publication, click here

Scottish Intercollegiate Guidelines Network (2010) SIGN Guideline 116: Management of diabetes.

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