Mortality and diabetic foot related complications

NewsBot · Jun 28, 2022

Diabetic foot ulcers’ impact on survival: an association study using the conditional inference tree approach
M. Monteiro-Soares et al
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Background: Up to a third of people with diabetes worldwide will develop a diabetic foot ulcer (DFU) during their lifetime. DFUs precede 80% of limb amputations (LEA). At five years, mortality after diabetes-related LEA exceeds 70%, and the risk of death for people living with DFU is 2.5 times the risk for those without one. However, risk factors are still not fully understood.
Aim: To study the association between DFU and mortality in adults with diabetes adjusted for modifiable and non-modifiable risk factors.
Method: Cohort with 595 adults with diabetes who attended a Podiatry appointment at a Portuguese Diabetic Foot Outpatient Clinic, from January 2010 to March 2013, and followed up to 31 December 2020, or death. The conditional inference tree (CIT) was used to identify predictors of mortality. CIT is a nonparametric statistical model used for making classifications or predictions based on tree-structure recursive partitioning. The variables considered were: age, gender, diabetes duration, insulin therapy, glycemic control, living alone, retinopathy, physical impairment, visual impairment, nephropathy, lower limb revascularization, diabetic peripheral neuropathy (DPN), cardiovascular disease, previous DFU, previous LEA, hypolipidemic and anticoagulant agents. All the statistical analyses were carried out using the package partykit, in R software.
Results: At baseline, diabetes median duration was 15 (IQ [inter-quartile] range 10-23) years, with the participants' median age of 67.3 (59.2-75.4) years. Participants were mostly male (57.1), with previous DFU (54.4%), with DPN (56.5%) and cardiovascular disease (83.4%); 10.7% had previous LEA, 46.4% had retinopathy, 19.3% nephropathy. During a median follow-up of 8.1 (IQ range 3.9-9.3) years, there were 318 (53.4%) deaths. The predictors of all-cause mortality identified by the CTI were previous DFU, age, and retinopathy. At the end of eight years of follow-up, the estimated survival probability (95% CI [confidence interval]) was 47.5 (35.6-63.4) % for people without a previous DFU, aged older than 65 years, and with retinopathy. For those without retinopathy, it was 73.7 (64.6-84.0) %. For people with a previous DFU and older than 65, the eight-year estimated survival probability was 25.0 (19.6-31.9) %, while for the younger ones, it was 56.9 (48.5-66.6) %. Retinopathy did not impact the survival probability for people with previous DFU.
Discussion: In this cohort of adults with diabetes, age, previous DFU, and retinopathy were the risk factors with a significant association with mortality. For participants with previous DFU, the highest mortality was observed for those aged older than 65. However, for adults with no previous DFU, mortality was associated not only with being older than 65 years but also with retinopathy. Retinopathy and DFU, both frequent, preventable and markers of diabetes control, significantly affected survival after adjustment for age.
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NewsBot · Jul 29, 2022

Diabetic Foot Risk Classification at the Time of Type 2 Diabetes Diagnosis and Subsequent Risk of Mortality: A Population-Based Cohort Study
Zhaonan Wang et al
Front Endocrinol (Lausanne). 2022 Jul 11;13:888924

Aim: We aimed to compare the mortality of individuals at low, moderate, and high risk of diabetic foot disease (DFD) in the context of newly diagnosed type 2 diabetes, before developing active diabetic foot problem.

Methods: This was a population-based cohort study of adults with newly diagnosed type 2 diabetes utilizing IQVIA Medical Research Data. The outcome was all-cause mortality among individuals with low, moderate, and high risk of DFD, and also in those with no record of foot assessment and those who declined foot examination.

Results: Of 225,787 individuals with newly diagnosed type 2 diabetes, 34,061 (15.1%) died during the study period from January 1, 2000 to December 31, 2019. Moderate risk and high risk of DFD were associated with increased mortality risk compared to low risk of DFD (adjusted hazard ratio [aHR] 1.50, 95% CI 1.42, 1.58; aHR 2.01, 95% CI 1.84, 2.20, respectively). Individuals who declined foot examination or who had no record also had increased mortality risk of 75% and 25% vs. those at low risk of DFD, respectively (aHR 1.75, 95% CI 1.51, 2.04; aHR 1.25, 95% CI 1.20, 1.30).

Conclusion: Individuals with new-onset type 2 diabetes who had moderate to high risk of DFD were more likely to die compared to those at low risk of DFD. The associations between declined foot examination and absence of foot examinations, and increased risk of mortality further highlight the importance of assessing foot risk as it identifies not only patients at risk of diabetic foot ulceration but also mortality.
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NewsBot · Sep 5, 2022

Global mortality of diabetic foot ulcer: a systematic review and meta-analysis of observational studies
Lihong Chen et al
Diabetes Obes Metab. 2022 Aug 20

Aims: Diabetic foot ulcer (DFU) is an important cause of morbidity, disability, and mortality. However, there was no comprehensive quantitative data on mortality worldwide. The aim of this study was to estimate the long-term mortality and risk factors in patients with DFU.
Methods: We systematically searched Medline (PubMed), Embase, Scopus, Web of Science, Cochrane Library, China Science and Technology Journal Database (CQVIP), China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Database (SinoMed), and Wanfang Data from Jan 1, 2011 to July 31, 2022. All observational studies that reported long-term mortality of patients with DFU were included. Random effect models were used to pool the reconstructed participant data from Kaplan-Meier curves. The primary outcome was the long-term survival of patients with DFU. An aggregate data meta-analysis was also performed.
Results: We identified 34 studies, with 124376 participants representing 16 countries， among whom there were 51386 deaths. Of these, 27 studies with 21171 patients were included in the Kaplan-Meier-based meta-analysis. The estimated Kaplan-Meier based survival rates were 86.9% (95% confidence interval [CI] 82.6%-91.5%) at 1 year, 66.9% (95%CI 59.3%-75.6%) at 3 years, 50.9% (95%CI 42.0%-61.7%) at 5 years, and 23.1% (95%CI 15.2%-34.9%) at 10 years. The results of the aggregate-data-based meta-analysis were similar. Cardiovascular disease and infection were the most common causes of death, accounting for 46.6% (95%CI 33.5%-59.7%) and 24.8% (95% CI 16.0%-33.5%), respectively. Patients with older age (per 1-year, Hazard ratio [HR] 1.054, 95%CI 1.045-1.063), peripheral artery disease (HR 1.882, 95%CI 1.592-2.225), chronic kidney disease (HR 1.535, 95%CI 1.227-1.919), end-stage renal disease (HR 3.586, 95%CI 1.333-9.643), amputation (HR 2.415, 95%CI 1.323-4.408), and history of cardiovascular disease (HR 1.449, 95%CI 1.276-1.645) had higher mortality risk.
Conclusions: This meta-analysis found that the overall mortality of DFU was high, with nearly 50% mortality within 5 years. Cardiovascular disease and infection were the leading two causes of death.
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NewsBot · Jan 30, 2023

The effect of comorbid factors and amputation level on mortality in geriatric patients with diabetic foot
Hüseyin Gökhan Karahan, Onur Çetin, Murat Gök, Hasan Furkan Akın, Abdurrahman Vural, Cemil Kayalı
Jt Dis Relat Surg. 2023;34(1):115-120

Objectives: The aim of this study was to evaluate the factors that influenced one-year and five-year mortality and to compare major and minor amputations in diabetic patients with comorbidities.

Patients and methods: Between February 2008 and November 2014, a total of 201 type 2 diabetic foot patients (147 males, 54 females; median age: 65.99 years; range, 50 to 92 years) who underwent amputation were retrospectively analyzed. The patients were divided into two groups according to their initial amputation level: Group 1 (n=100), minor amputation group, which included the distal region of the ankle joint and Group 2 (n=101), major amputation group, which included trans-tibial amputation, trans-femoral amputation and hip disarticulation. Clinical data including patients' demographic features, re-amputation degree, length of hospitalization, hyperbaric oxygen therapy, comorbidities, blood parameters, and survival rates were recorded.

Results: The regression analysis of one-year mortality found that the presence of cerebrovascular disease increased death by 2.463 times (p=0.002). Minor amputation increased mortality by 2.284 (p=0.006), and each unit increase in patient age increased mortality by 1.05 (p=0.008). Chronic renal failure increased death by 3.164 times (p<0.001) in the five-year mortality regression analysis.

Conclusion: Minor amputations have an effect on one-year mortality, as do cerebrovascular disease and age. On the other hand, chronic renal failure has a negative impact on five-year mortality. Minor amputations may have a detrimental effect on mortality due to the ongoing progression of diabetic foot disease and the involvement of comorbidities. Comorbidities associated with amputations of the diabetic foot have a significant impact on mortality.
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NewsBot · Feb 7, 2023

Mortality conversations between male Veterans and their providers prior to dysvascular lower extremity amputation
Alison W Henderson et al
Ann Vasc Surg. 2023 Feb 4;S0890-5096(23)00056-0

Background: Among patients facing lower extremity amputation due to dysvascular disease, mortality risk is very high. Given this, as well as the importance of a patient-centered approach to medical care, informing patients about their possible risk of dying may be important during pre-operative shared decision-making. The goal of this investigation was to gain an understanding of patient and provider experiences discussing mortality within the context of amputation within the Veterans Health Administration.

Methods: Semi-structured interviews were performed with Veterans with peripheral arterial disease and/or diabetes, vascular and podiatric surgeons, and physical medicine and rehabilitation physicians. Interviews were analyzed using team-based content analysis to identify themes related to amputation level decisions.

Results: We interviewed 22 patients and 21 surgeons and physicians and identified three themes related to conversations around mortality: 1) both patients and providers report that mortality conversations are not common prior to amputation; 2) while most providers find value in mortality conversations, some express concerns around engaging in these discussions with patients; and 3) some patients perceive mortality conversations as unnecessary, but many are open to engaging in the conversation.

Conclusions: Providers may benefit from introducing the topic with patients, including providing the context for why mortality conversations may be valuable, with the understanding that patients can always decline to participate should they not be interested or comfortable discussing this issue.
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NewsBot · May 2, 2023

Should Long-Term Survival in Elderly Patients Presenting with Diabetic Foot Complications Impact Treatment Decision Making?
Erwin Yii et al
Int J Low Extrem Wounds. 2023 Apr 20

Patients presenting with diabetic foot ulceration (DFU) and associated complications often require revascularisation. Although current evidence advocates for an open bypass first strategy if patients are expected to live more than two years, this may not be appropriate in octogenarians. We sought to investigate the survival of patients aged over 70 years presenting with complicated DFU and chronic limb threatening ischaemia (CLTI) to clarify its prognosis and guide subsequent management. A database of patients admitted into a large tertiary service over the age of 70 years with DFU and CLTI between 2014 and 2017 were included. Survival data was obtained from medical records and public obituaries through to 2020. Patients were divided into three age groups: seventies (70-79 years), eighties (80-89 years) and nineties (≥90 years). Survival was evaluated using a stratified log-rank test and Kaplan-Meier methods. A total of 323 patients were included for analysis. Survival information was available for 225 patients (69%). Mean duration of follow-up was 19 months. There were 113 deaths recorded (35%). Mean survival for patients in their seventies, eighties and nineties was 63 months (95% CI 48.8-65.5), 37 months (95% CI 27.4-44.9) and 6 months (95% CI 2.3-19.2), respectively. In patients over 70 years of age presenting with DFU and CLTI, long-term survival decreases rapidly with increasing age, especially in the octogenarians. With recent technological advances and reduced morbidity, an endovascular approach may sufficiently treat acute presentations in octogenarians while reserving an open first strategy for younger patients with better long-term survival and adequate autologous conduit.
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Mortality and diabetic foot related complications

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Mortality and diabetic foot related complications

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Nutritional Status Predicts Mortality in Diabetic Foot Ulcers Patients

Illness Beliefs Predict Mortality in Patients with Diabetic Foot Ulcers

Rectal colonization is a risk factor for mortality in patients with diabetic foot infections

Mortality rate in diabetic foot

Subungual/ feet Melanoma Mortality rates in Australia

Daily Activity Energy Expenditure and Mortality Among Older Adults

Eternal Life Foot Braces - for immortality.

Share This Page

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