Diabetic Retinopathy associated with Higher Risk of DFU & Amputation in diabetes Patients

Gauthier Borderie, with colleagues, investigated, Is Diabetic Retinopathy (DR) related to Diabetic Foot Ulcer (DFU) development?

DR and IWGDF stratification were registered in hospitalized patients (2009 -2017). The patients had a history of uncontrolled/complicated type 2 diabetes. Until 2020, new Diabetic Foot Ulcers were registered.

Diabetic Retinopathy subjects were categorized by survival analyses and multivariate Cox regression adjusted for confounders.

The study results are:

· There were 522 patients in the study.

· 57.9% were male aged 62 years.

· The subjects had diabetes of a duration of 14±10 years.

· The HbA1c was 8.7±1.8%.

· There were 33.9% macroangiopathies and 44.8% diabetic kidney diseases.

· DFU risk grades were 0 (43.3%), 1 (23.9%), 2 (7.1%), and 3 (25.6%).

· The follow-up period was 52 months.

· There were 58 new Diabetic Foot Ulcers and 18 lower-limb amputations in Diabetic Retinopathy patients present in 140 patients constituting 26.8%.

· There were Adjustments for age, sex and conventional risk factors and complications. The conventional risk factors were diabetes duration and control, arterial hypertension, and dyslipidemia.

· Diabetic Retinopathy was associated with a greater incidence of Diabetic Foot Ulcers.

· Diabetic Retinopathy was related to new DFUs with an HR of 2.51 (Adjusted for the IWGDF classification)

· The HR for amputations was 3.56.

· The relationship persisted in ascending IWGDF grades, with DFU incidence from 2/1000 to 121/1000 patient-years (from grade 0 to 3 and from no DR to DR) and amputations from 0 to 38/1000 patient-years (from grade 0 to 3 and from no DR to DR).

To conclude, In type 2 diabetes, Diabetic retinopathy is independently related to foot ulcers and amputation incidence in hospitalized patients.

Further reading:

Borderie, Gauthier, et al. “Diabetic Retinopathy Relates to the Incidence of Foot Ulcers and Amputations in Type 2 Diabetes.” Diabetes/Metabolism Research and Reviews, Wiley, Dec. 2022. Crossref, https://doi.org/10.1002/dmrr.3605