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
Source

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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NewsBot · Jun 15, 2023

Comparison of below-knee and above-knee amputations with demographic, comorbidity, and haematological parameters in patients who died
Cafer Özgür Hançerli, Necati Doğan
J Foot Ankle Res. 2023 Jun 13;16(1):36

Background: This study aimed to establish mortality predictive parameters with a higher contribution to mortality by comparing the demographic data, comorbid factors, and haematological values of patients who underwent below-knee and above-knee amputation and had died during the follow-up period.

Materials and methods: Between March 2014 and January 2022, 122 patients in a single centre who developed foot gangrene due to chronic diabetes and underwent below-knee or above-knee amputation were evaluated retrospectively. Patients who died of natural causes during the post-operative period were included in the study. Those who were amputated below the knee were assigned to Group 1, and those who were amputated above the knee were assigned to Group 2. The patients' age, gender, side of amputation, comorbid diseases, American Society of Anaesthesiologists (ASA) score, Charlson comorbidity index (CCI), death time, and haematological values at the time of first admission were compared between the two groups and statistical analyses were performed.

Results: Group 1 (n = 50) and Group 2 (n = 37) had similar distributions in terms of age, gender, side of operation, number of comorbidities, and CCI (p > 0.05). Group 2's mean ASA score and c-reactive protein (CRP) levels were statistically higher than those of Group 1 (p < 0.05). Death time, albumin value, and HbA1c levels were statistically lower in Group 2 than in Group 1 (p < 0.05). There were no significant differences between the groups in haemogram, white blood cells (WBC), lymphocytes, neutrophils, creatinine, and Na values at the time of first admission (p > 0.05).

Conclusion: A high ASA score, low albumin value, and high CRP value were significant predictors of high mortality. Creatinine levels and HbA1c values were quite ineffective in predicting mortality.
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NewsBot · Jun 16, 2023

Extracellular to Intracellular Water Ratio Determined by Bioimpedance is Associated with Mortality in Patients Admitted for Diabetic Foot Ulcers
María Eugenia López-Valverde et al
Int J Low Extrem Wounds. 2023 Jun 15

An increased extracellular water/intracellular water (ECW/ICW) ratio determined by bioimpedance has been related to mortality in patients undergoing hemodialysis. We aimed to evaluate the impact of body water distribution in patients with diabetes-related foot ulcers. Seventy-six patients were evaluated with bioimpedance, handgrip strength, and laboratory examinations. The ECW/ICW ratio is a prognostic factor for early mortality.
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NewsBot · Aug 14, 2023

Triglyceride-glucose index is strongly associated with
all-cause mortality in elderly females with diabetic foot
ulcers: A 9-year follow-up study
Xiuxian Huang et al
Source

This study aims to explore the association between the triglyceride-glucose
(TyG) index and all-cause mortality in patients with diabetic foot ulcers
(DFUs) through an ambispective cohort study. A total of 555 inpatients with
DFUs were qualified to participate in the trial study from 2013 to 2022.
Throughout a median 63-month period, all subjects were followed up every
6 months. According to the three quantiles of the TyG index, participants were
divided into three groups: low-level (≤8.75, n = 185), moderate-level
(8.76–9.33, n = 185) and high-level (≥9.34, n = 185). The association between
the TyG index and all-cause mortality in patients with DFUs was then
assessed. During the follow-up period, out of 555 patients with DFUs, 116 died
(20.9%). After adjusting for confounding factors, the TyG index was positively
associated with all-cause mortality in patients with DFUs (HR = 1.733; 95%
CI = 1.341–2.241; p < 0.001). Compared with the low-level TyG index, the
moderate-level TyG index (HR = 1.685; 95% CI = 1.011–2.810; p = 0.045) and
the high-level TyG index (HR = 2.769; 95% CI = 1.678–4.568; p < 0.001) were
positively correlated with all-cause mortality in patients with DFUs. Additionally, in subgroup analysis, both females (HR = 1.905; 95% CI = 1.250–2.904;
p = 0.003), males (HR = 1.729; 95% CI = 1.240–2.409; p = 0.001), younger
(<65 years old) (HR = 1.467; 95% CI = 1.008–2.135; p = 0.046) and elderly
(≥ 65) (HR = 1.933; 95% CI = 1.339–2.791; p < 0.001) showed a positive correlation between TyG index and all-cause mortality rate in patients with DFUs.
Furthermore, in the high-level TyG index group compared, males
(HR = 2.699; 95% CI = 1.457–4.998) and participants aged <65 years
(HR = 2.031; 95% CI = 0.972–4.242), with the TyG index level increase by 1.0,
the risk for all-cause mortality increased 3.277-fold in females (HR = 4.277;
95% CI = 1.645–11.124) and 1.909-fold in elderly aged ≥65 years (HR = 2.909;
95% CI = 1.486–5.695), respectively. Kaplan–Meier survival curve analysis
showed that the higher the TyG index level, the higher risk of all-cause mortality in patients with DFUs (log-rank, all p < 0.001). Briefly, this study implies a
strong positive correlation between the TyG index and all-cause mortality in
patients with DFUs, especially in older women. Therefore, special attention
should be paid to elderly females with DFUs because they have a higher TyG
index level and risk of all-cause mortality than other populations in daily clinical practice.
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NewsBot · Sep 19, 2023

Diabetes foot complications and standardized mortality rate in type 2 diabetes
Mike Stedman et al
Diabetes Obes Metab. 2023 Sep 18

Aim: To quantify the impact of foot complications on mortality outcomes in people with type 2 diabetes (T2D), and how routinely measured factors might modulate that risk.

Materials and methods: Data for individuals with T2D for 2010-2020, from the Salford Integrated Care Record (Salford, UK), were extracted for laboratory and clinical data, and deaths. Annual expected deaths were taken from Office of National Statistics mortality data. An index of multiple deprivation (IMD) adjusted the standardized mortality ratio (SMR_IMD). Life years lost per death (LYLD) was estimated from the difference between expected and actual deaths.

Results: A total of 11 806 T2D patients were included, with 5583 new diagnoses and 3921 deaths during 2010-2020. The number of expected deaths was 2135; after IMD adjustment, there were 2595 expected deaths. Therefore, excess deaths numbered 1326 (SMR_IMD 1.51). No foot complications were evident in n = 9857. This group had an SMR_IMD of 1.13 and 2.74 LYLD. In total, 2979 patients had any foot complication recorded. In this group, the SMD_IMR was 2.29; of these, 2555 (75%) had only one foot complication. Patients with a foot complication showed little difference in percentage HbA1c more than 58 mmol/mol. In multivariate analysis, for those with a foot complication and an albumin-to-creatinine ratio of more than 3 mg/mmol, the odds ratio (OR) for death was 1.93, and for an estimated glomerular filtration rate of less than 60 mL/min/1.73m2 , the OR for death was 1.92.

Conclusions: Patients with T2D but without a foot complication have an SMR_IMD that is only slightly higher than that of the general population. Those diagnosed with a foot complication have a mortality risk that is double that of those without T2D
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NewsBot · Sep 29, 2023

High Mortality in Patients With an Ischemic Foot Ulcer Following Revascularization
Kochaphan Phirom et al
Int J Low Extrem Wounds. 2023 Sep 26

Critical limb ischemia (CLI) is the advanced stage of peripheral arterial disease, which impairs blood flow to the extremities due to occlusion of arteries, in which patients suffer from ischemic pain at rest and gangrene or ulcers. It is frequently accompanied by major adverse cardiac events, resulting in exceedingly high mortality from a cardiac or cerebrovascular event in this population. Although there have been considerable amounts of novel and costly revascularization and wound dressing technology, mortality is still high. Therefore, the risk factors for such high mortality need to be addressed. This review aimed to summarize the potential risk factors for mortality in patients with CLI of the lower extremities. There are several such risk factors, including modifiable and nonmodifiable risk factors. This review further discusses some highlighted major modified risk factors, including renal failure, cardiovascular, and diabetes. The strategy of regular surveillance and modification of such risk factors in any patients with CLI should be developed.
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NewsBot · Oct 3, 2023

Survival Prediction in Diabetic Foot Ulcers: A Machine Learning Approach
Alina Delia Popa et al
J Clin Med. 2023 Sep 7;12(18):5816

Our paper proposes the first machine learning model to predict long-term mortality in patients with diabetic foot ulcers (DFUs). The study includes 635 patients with DFUs admitted from January 2007 to December 2017, with a follow-up period extending until December 2020. Two multilayer perceptron (MLP) classifiers were developed. The first MLP model was developed to predict whether the patient will die in the next 5 years after the current hospitalization. The second MLP classifier was built to estimate whether the patient will die in the following 10 years. The 5-year and 10-year mortality models were based on the following predictors: age; the University of Texas Staging System for Diabetic Foot Ulcers score; the Wagner-Meggitt classification; the Saint Elian Wound Score System; glomerular filtration rate; topographic aspects and the depth of the lesion; and the presence of foot ischemia, cardiovascular disease, diabetic nephropathy, and hypertension. The accuracy for the 5-year and 10-year models was 0.7717 and 0.7598, respectively (for the training set) and 0.7244 and 0.7087, respectively (for the test set). Our findings indicate that it is possible to predict with good accuracy the risk of death in patients with DFUs using non-invasive and low-cost predictors.
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NewsBot · Dec 24, 2023

Life expectancy of patients with diabetic foot sepsis post-lower extremity amputation at a regional hospital in a South African setting. A retrospective cohort study
Thoriso C Mokoala et al
Surgeon. 2023 Dec 14:S1479-666X(23)00143-9

Background: Diabetes foot sepsis (DFS) is the leading cause of amputation of lower extremities. Over 50 % of patients who have had major lower extremity amputation due to DFS are dead within 4 years following the procedure.

Aim: To determine the life expectancy of patients following amputation for DFS at a regional hospital in South Africa.

Methods: We conducted an audit of patients who had DFS and were admitted over a 5-year period. The duration from admission to time of death was recorded in days. Occurrence of death was confirmed from family members of the deceased using structured telephonic interview questionnaires. Categorical findings were summarized using actual counts and percentages and compared using either the Chi-square or Fisher's exact test. We used the mean with standard deviation or median and range to compare parametric and non-parametric continuous data, respectively. The Shapiro-Wilk test was used to test normality of data. Multivariate logistic regression was done to establish factors that were strongly associated with the mortalities. Adjusted survival curves were added to compare the rate of occurrence of mortality between males and females with age as a confounder. Statistical significance was set at a p-value below 0.05.

Results: 197 were found of which 100 % of participants had Type 2 diabetes mellitus and 63.5 % were males. Associated comorbidities included hypertension in 73.6 %, obesity in 66 %, alcohol use in 64.5 % and smoking in 58.4 %. 190 participants had an amputation and 19.3 % died.

Conclusion: DFS was more common in males and 96 % of the patients had an amputation. Mortality rate within 4 years following amputation was 19.3 % and was higher in females and individuals with multiple comorbidities.
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NewsBot · Jan 18, 2024

Independent association of history of diabetic foot with all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study
Martina Vitale, Emanuela Orsi, Anna Solini, Monia Garofolo, Veronica Resi, Enzo Bonora, Cecilia Fondelli, Roberto Trevisan, Monica Vedovato, Giuseppe Penno & Giuseppe Pugliese
Cardiovascular Diabetology volume 23, Article number: 34 (2024)

Background
Foot ulcers and/or infections are common long-term complications of diabetes and are associated with increased mortality, especially from cardiovascular disease, though only a few studies have investigated the independent contribution of these events to risk of death. This study aimed at assessing the association of history of diabetic foot with all-cause mortality in individuals with type 2 diabetes, independent of cardiovascular risk factors, other complications, and comorbidities.

Methods
This prospective cohort study enrolled 15,773 Caucasian patients in 19 Italian centers in the years 2006–2008. Prior lower extremity, coronary, and cerebrovascular events and major comorbidities were ascertained by medical records, diabetic retinopathy by fundoscopy, diabetic kidney disease by albuminuria and estimated glomerular filtration rate, cardiovascular risk factors by standard methods. All-cause mortality was retrieved for 15,656 patients on 31 October 2015.

Results
At baseline, 892 patients (5.7%) had a history of diabetic foot, including ulcer/gangrene and/or amputation (n = 565; 3.58%), with (n = 126; 0.80%) or without (n = 439; 2.78%) lower limb revascularization, and revascularization alone (n = 330; 2.09%). History of diabetic foot was associated with all-cause death over a 7.42-year follow-up (adjusted hazard ratio, 1.502 [95% confidence interval, 1.346–1.676], p < 0.0001), independent of confounders, among which age, male sex, smoking, hemoglobin A1c, current treatments, other complications, comorbidities and, inversely, physical activity level and total and HDL cholesterol were correlated independently with mortality. Both ulcer/gangrene and amputation alone were independently associated with death, with a higher strength of association for amputation than for ulcer/gangrene (1.874 [1.144–3.070], p = 0.013 vs. 1.567 [1.353–1.814], p < 0.0001). Both ulcer/gangrene/amputation and lower limb revascularization alone were independently associated with death; mortality risk was much higher for ulcer/gangrene/amputation than for revascularization (1.641 [1.420–1.895], p < 0.0001 vs. 1.229 [1.024–1.475], p = 0.018) and further increased only slightly for combined ulcer/gangrene/amputation and revascularization (1.733 [1.368–2.196], p < 0.0001).

Conclusions
In patients with type 2 diabetes, an history of diabetic foot event, including ulcer/gangrene, amputation, and lower limb revascularization, was associated with a ~ 50% increased risk of subsequent death, independent of cardiovascular risk factors, other complications and severe comorbidities, which were also significantly associated with mortality. The association with mortality was greatest for amputation, whereas that for revascularization alone was relatively modest.
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NewsBot · Feb 16, 2024

Diabetic foot ulcer is associated with cardiovascular-related mortality and morbidity - a systematic review and meta-analysis of 8062 patients
Brian Zhaojie Chin et al
Endocrine. 2024 Jan 27

Objectives: To conduct a systematic review and meta-analysis of prevalence of cardiovascular-related morbidity and mortality in patients with diabetic foot ulcers (DFU), as well as compare risks of cardiovascular-related morbidity and mortality between diabetic patients with and without DFU.

Methods: A systematic search was conducted on Medline, Embase, and Cochrane databases for randomized controlled trials and observational studies which explored the association between DFU and cardiovascular-related morbidity & mortality, or compared differences in hazard ratios of cardiovascular diseases between diabetics with and without DFU. Frequentist, pairwise meta-analysis was performed on studies with two comparator arms, whereas single-arm studies reporting pooled incidences of cardiovascular-related mortality and morbidity were calculated based on exact binomial distributions. A random-effect meta-analysis model was used with heterogenicity of studies assessed using I2, τ2, and χ2 statistics.

Results: 10 studies were identified and included in the systematic review & meta-analysis of 8602 patients. DFU was consistently found to have significant association with cardiovascular-related morbidity and mortality, with pooled prevalences of all cause cardiovascular-related morbidity (37.1%), IHD (44.7%), CHF (25.1%), CAD (11.7%), and CVA (10.9%), and all cause cardiovascular-related mortality (14.6%), fatal IHD (6.2%), fatal CHF (3.67%), fatal CAD (7.92%), and fatal CVA (1.99%). Diabetic patients with DFU were found to have significantly increased risk of IHD (RR 1.25), CVA (RR 2.03), and all-cause cardiovascular-related mortality (RR 2.59) compared to those without DFU.

Conclusions: The presence of DFU is associated with major adverse cardiac events. The alarming rates of cardiovascular-related morbidity and mortality in DFU patients highlight its potential role as a marker of cardiovascular complications and should prompt early clinical investigation and management.
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NewsBot · May 17, 2024

Diabetic foot ulcers, their characteristics, and trends in survival: Real world outcomes at a tertiary care facility in India
Zachariah Thomas et al
Diabetes Metab Syndr. 2024 Apr 24;18(4):

Aims: Characteristics of diabetes-related foot ulcers (DFU), association with recurrence and amputation are poorly described in the Asian Indian population.

Methods: A prospectively maintained database was reviewed to characterize DFU and its association with amputation and recurrence.

Results: Of 200 patients, 63.5 % were male, the median age was 62 years (Min-Max:40-86), and median BMI was 27.90 kg/m2 (Min-Max:18.5-42.7). Median duration of Diabetes mellitus was 15 years (Min-Max:2-43). Complete healing occurred at a median of three months (Min-Max:0.23-37.62). Amputation for the current ulcer was required in 43.4 % of individuals. Ulcer recurrence was documented in 42.4 % instances, 66.1 % evolving on the ipsilateral side. Previous amputation was associated with the risk of subsequent amputation (Adjusted OR-3.08,p-0.047). Median time to ulcer recurrence was 4.23 years among those with amputation, in contrast to 9.61 years in those with healing. Cardiovascular death was the commonest cause of mortality, followed by sepsis. At a median follow up of 6.08 years, mortality at 1,3,5 and 10 years was 2.5 %,2.5 %,8.2 % and 30.9 % respectively among those who underwent amputation versus 0 %,0 %,10.1 % and 24.5 % respectively for those who achieved healing.

Conclusions: Patients with DFU in India incur amputations at rates higher than conventionally described. With previous amputation, subsequent amputation risk triples. Ten-year mortality is 25%-30 %. Underestimates of the burden of recurrence and mortality are consequential of limited follow-up.
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NewsBot · Jul 2, 2024

Diabetic foot disease carries an intrinsic high risk of mortality and other severe outcomes in type 2 diabetes: a propensity score-matched retrospective population-based study
Bogdan Vlacho, Magdalena Bundó, Judit Llussà, Jordi Real, Manel Mata-Cases, Xavier Cos, Diana Tundidor, Francesco Zaccardi, Kamlesh Khunti, Edward B. Jude, Josep Franch-Nadal & Dídac Mauricio
Cardiovascular Diabetology volume 23, Article number: 209 (2024)

Background
To evaluate the association between diabetic foot disease (DFD) and the incidence of fatal and non-fatal events in individuals with type 2 diabetes (T2DM) from primary-care settings.

Methods
We built a cohort of people with a first DFD episode during 2010–2015, followed up until 2018. These subjects were 1 to 1 propensity score matched to subjects with T2DM without DFD. The incidence of all-cause mortality, the occurrence of new DFD, amputations, cardiovascular diseases, or composite outcome, including all-cause mortality and/or cardiovascular events during the follow-up period, were calculated. A Cox proportional hazard analysis was conducted to evaluate the hazard ratios (HR) for different events.

Results
Overall, 11,117 subjects with T2DM with a first episode of DFD were compared with subjects without DFD. We observed higher incidence rates (IRs) for composite outcome (33.9 vs. 14.5 IR per 100 person-years) and a new DFD episode event (22.2 vs. 1.1 IR per 100 person-years) in the DFD group. Compared to those without DFD, those with a first episode of DFD had a higher HR for all events, with excess rates particularly for amputation and new DFD occurrence (HR: 19.4, 95% CI: 16.7–22.6, HR: 15.1, 95% CI: 13.8–16.5, respectively) was found.

Conclusions
Although DFD often coexists with other risk factors, it carries an intrinsic high risk of morbidity and mortality in individuals with T2DM. DFD should be regarded as a severe complication already at its onset, as it carries a poor clinical prognosis.
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NewsBot · Sep 28, 2024

Red blood cell distribution as Potential Predictor of Mortality in Diabetic Foot Patients
Chunmei Gou et al
Source

Background Red blood cell distribution width (RDW) reflects the heterogeneity of red blood cell volume, which reflects the variable width of red blood cell (RBC). RDW has been proved as predictor of mortality among several diseases. The purpose of this study is to analyze the relationship between RDW and mortality of diabetic foot patients. Methods We first collect clinic data from the public database MIMIC-III. Kruskal Wallis rank sum test was used to analyze the association between RDW and DF mortality, and to evaluate the relationship between them. Univariate and multivariate logistic regression analysis was used for determining the risk factors and prognosis of DF patients. Results A total of 283 patients were included in this study, with an average age of 64.0 [54.0,70.5] years, including 193 males and 90 females. We divided RDW into three groups (high, moderate and low) according to RDW tertiles and then compared the mortality of the three groups. The high RDW group (RDW > 16.8%) had significant higher mortality (P = 0.031). In multivariate logistic regression analysis, RDW, SOFA score and APS are risk factors for death in diabetic foot. After adjusting for confounding factors in model II, RDW remains a particularly strong predictor of mortality. Conclusions We confirm that RDW is an independent predictor of mortality in DF patients,and the higher the RDW, the higher the mortality of DF patients.
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NewsBot · Sep 28, 2024

Mortality rates in people presenting with a new diabetes-related foot ulcer: a cohort study with implications for management
Naomi Holman et al
Diabetologia. 2024 Sep 27

Aims/hypothesis: People with diabetes-related foot ulcers (DFUs) have high mortality rates. This analysis assesses the impact of selected risk factors on short-term mortality using a population registered in the National Diabetes Foot Care Audit (NDFA).

Methods: Mortality rates at 12, 26 and 52 weeks was assessed in people with a new DFU registered by a specialist diabetes footcare service in the NDFA in England and Wales between April 2017 and March 2022. Poisson regression models were created to explore risk factors for mortality.

Results: In 71,000 people registered with a new DFU, mortality rates at 12, 26 and 52 weeks was 4.2%, 8.2% and 14.4%, respectively. At 26 weeks, higher mortality rates was associated with older age (rate ratio 2.15; 95% CI 2.03, 2.28, for age ≥80 years vs age 65-79 years), certain ulcer characteristics (area ≥1 cm2 [1.50; 95% CI 1.42, 1.59], deep ulcers [1.26; 95% CI 1.18, 1.35] or hindfoot location [1.53; 95% CI 1.44, 1.62]) and recorded evidence of ischaemia in the lower limb (1.78; 95% CI 1.69, 1.88) and various comorbidities (heart failure [2.13; 95% CI 2.00, 2.26], myocardial infarction [1.45; 95% CI 1.29, 1.63], stroke [1.37; 95% CI 1.22, 1.53], renal replacement therapy [2.34; 95% CI 2.09, 2.61] and chronic kidney disease stage 3 or greater [1.20; 95% CI 1.12, 1.29]). The 26-week mortality rate exceeded 25% for 7.3% of all individuals, rising to 11.5% of those aged 65 years and older, and 22.1% of those aged 80 years and over.

Conclusions/interpretation: Short-term mortality rates in people with a DFU is high. Teams managing people with DFUs should consider modifying the burdensome interventions and care required to heal such ulcers so maximising the quality of residual life, rather than focusing exclusively on healing.
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NewsBot · Oct 17, 2024

Mortality and Readmission Rates for Inpatients with Diabetic Foot Ulcer in a Tertiary, Urban Medical Center: A Five-Year Retrospective Review
Azucena Herrera Chancay, MD, Raul Lopez Fanas, MD, Humera Tabassum, MD, Johanna Daily, MD, Alyson Myers, MD
Journal of the Endocrine Society, Volume 8, Issue Supplement_1, October-November 2024, bvae163.852, https://doi.org/10.1210/jendso/bvae163.852

Background: Diabetic Foot Ulcer (DFU) is a severe complication of diabetes mellitus and is associated with high rates of morbidity and mortality. The incidence of DFUs and amputation disproportionately impact Black and Hispanic populations. DFU is also associated with a high rate of hospital readmissions and prolonged length of stay (LOS). The goal of this study was to examine 1-year mortality data, LOS and readmission rate. Methods: This study was a retrospective chart review of 1348 patients admitted to three hospitals in our system in the Bronx from 6/1/16 to 5/31/21. Data was extracted from the EPIC® electronic health records, based on the diagnoses ICD 10 codes, E10.621 and E11.622. Inclusion criteria was patients admitted with an active DFU regardless of other admission diagnosis, age 18 years or above. The index admission was defined as the first admission in our medical records within the date range. Patients were excluded if their index admission was not accessible through our EMR. Simple logistic regression and multiple logistic regression were used to analyze the association between variables of interest and mortality at index admission and at 1-year, LOS and re admissions. Results: Of the 650 eligible patients, the mean age was 59 + 13 years, 70% of patients were male, and majority were non-White (88%). Mortality was 1% during the index admission and the risk increased to 6% at 1 year after the index admission. Readmission with an active DFU from the index admission occurred in 15% of patients within 30-days, 32% of patients within 90 days, and 55% of patients within 1 year. The mean length of stay was 9 +7.5 days. Discussion: Our study in an urban region has identified high rates of mortality and costs associated with DFU, which has been reported in many settings. This patient population is high risk for poor outcomes and targeted programs are needed to reduce mortality and provide care to reduce readmissions. Future studies that explore the challenges of DFU health care and that test interventions are needed to improve DFU related health outcomes.
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NewsBot · Nov 10, 2024

Increased risk of major adverse cardiovascular events in patients with deep and infected diabetes-related foot ulcers
Nick S. R. Lan, Jonathan Hiew, Ivana Ferreira, J. Carsten Ritter, Laurens Manning, P. Gerry Fegan, Girish Dwivedi & Emma J. Hamilton
Diabetologia: 07 November 2024

Aims/hypothesis
Diabetes-related foot ulceration (DFU) is associated with increased cardiovascular risk, but the mechanisms remain unclear. Inflammation and infection are mediators of CVD, which may be important in DFU.

Methods
Prospectively collected data from patients attending a multidisciplinary DFU service were analysed. A deep ulcer was defined as one that reached muscle, tendon or deeper structures. Patients were categorised into four DFU groups: not deep and no infection (D−/I−), not deep but infected (D−/I+), deep with no infection (D+/I−) or deep with infection (D+/I+). Incident major adverse cardiovascular events (MACE) were defined as hospitalisation for myocardial infarction, stroke or transient ischaemic attack, or heart failure. Survival analyses were performed using the logrank test and multivariate Cox regression.

Results
Of 513 patients, 241 (47.0%) were in the D−/I− group, 110 (21.4%) were in the D−/I+ group, 35 (6.8%) were in the D+/I− group and 127 (24.8%) were in the D+/I+ group. MACE or all-cause mortality occurred in 75 patients (14.6%), and MACE alone occurred in 46 patients (9.0%) after median follow-up of 381 days (IQR 220–551) and 404 days (IQR 228–576), respectively. Infection was associated with significantly higher MACE or all-cause mortality (21.5% vs 8.7%; p<0.001) and MACE alone (13.5% vs 5.1%; p=0.003). MACE or all-cause mortality was significantly higher in the D+/I+ group (D−/I− 7.9%; D−/I+ 15.5%; D+/I− 14.3%; D+/I+ 26.8%; p<0.001), as was MACE alone (D−/I− 5.0%; D−/I+ 10.9%; D+/I− 5.7%; D+/I+ 15.7%; p=0.017). Infection and a deep ulcer were independent predictors of adverse outcomes.

Conclusions/interpretation
Deep and/or infected DFUs are associated with increased cardiovascular risk compared with DFUs that are not deep or infected. These findings provide a potential mechanistic explanation that requires investigation.
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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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