Foot ulcer and risk of lower limb amputation or death in people with diabetes: a national population-based retrospective cohort study

Chamberlain, R. C. et al. (2022) Foot ulcer and risk of lower limb amputation or death in people with diabetes: a national population-based retrospective cohort study. Diabetes Care, 45(1), pp. 83-91. (doi: 10.2337/dc21-1596) (PMID:34782354)

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Abstract

Objective: To describe incidence of foot ulceration and amputation-free survival associated with foot ulceration status in a national population-based cohort study of people with diabetes. Research Design and Methods: The study population included 233,459 people with diabetes who were alive in Scotland on 1 January 2012 identified from the national population-based register (national prevalence 4.9%). Characteristics of patients identified from linked hospital and mortality records during follow-up to the end of November 2017 were compared by outcome. Cox regression was used to assess the association between history of foot ulcer and amputation-free survival. Results: The population included 23,395 people with type 1 diabetes and 210,064 people with type 2 diabetes. In total there were 13,093 (5.6%) people who had a previous foot ulceration, 9,023 people who developed a first ulcer, 48,995 who died, and 2,866 who underwent minor or major amputation during follow-up. Overall incidence of first-time foot ulcers was 7.8 per 1,000 person-years (95% CI7.6–7.9) and 11.2 (11.0–11.4) for any ulcer. Risk factors for reduced amputation-free survival included social deprivation, mental illness, and being underweight in addition to conventional cardiovascular risk factors. Adjusted hazard ratios (95% CI) were 2.09 (1.89–2.31) for type 1 diabetes and 1.65 (1.60–1.70) for type 2 diabetes. Conclusions: The overall incidence of foot ulceration in a population-based study of people with diabetes was 11.2 per 1,000 person-years. Foot ulceration is associated with lower amputation-free survival rate, a potential measure of effectiveness of care among people with diabetes. Mental illness and social deprivation are also highlighted as risk factors.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Lindsay, Dr Robert and Kennon, Dr Brian and Petrie, Professor John and Sattar, Professor Naveed
Authors: Chamberlain, R. C., Fleetwood, K., Wild, S. H., Colhoun, H. M., Lindsay, R. S., Petrie, J. R., McCrimmon, R. J., Gibb, F., Philip, S., Sattar, N., Kennon, B., and Leese, G. P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Diabetes Care
Publisher:American Diabetes Association
ISSN:0149-5992
ISSN (Online):1935-5548
Published Online:15 November 2021
Copyright Holders:Copyright © 2021 American Diabetes Association
First Published:First published in Diabetes Care 45(1): 83-91
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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