Foot ulceration in diabetes mellitus associated with high mortality, finds Study

CHINA: People who have diabetic foot ulcers (DFUs) die at an excessively high rate, with nearly 50% mortality within 5 years states a research study published in Diabetes, Obesity and Metabolism. The two leading causes of death were found to be cardiovascular disease and infection. 

One of the most prevalent consequences for those with poorly controlled diabetes mellitus is diabetic foot ulcers. Poor foot care, peripheral vascular disease, underlying neuropathy, and poor glycemic control are the usual causes. More hospitalizations are brought on by diabetic foot ulcers than any other condition. Compared to diabetes alone, diabetic foot ulcers predict an almost 2-fold rise in overall mortality.

The researchers aimed to determine the risk variables and long-term mortality for patients with DFU.

To conduct the study, they systematically searched various journal databases from Jan 1, 2011, to July 31, 2022. All observational studies that documented the long-term mortality of DFU patients were considered. The participant data from Kaplan-Meier curves were pooled using random effect models. The Kaplan-Meier-based meta-analysis comprised 27 studies with 21171 patients. The long-term survival of patients receiving DFU was the main result. Additionally, a meta-analysis of collective data was carried out.

Key findings of the research:

• The computed Kaplan-Meier-based survival rates were 86.9% at 1 year, 66.9% at 3 years, 50.9% at 5 years, and 23.1% at 10 years.
• The most frequent causes of death, accounting for 46.6% and 24.8% respectively, were cardiovascular disease and infection.
• Patients who were older (per 1-year, Hazard ratio [HR] 1.054), had peripheral artery disease (HR 1.882), cardiovascular disease history (HR 2.415), chronic kidney disease (HR 1.535, 95% CI 1.227-1.919), end-stage renal disease (HR 3.586), had undergone amputation (HR 2.415), presented a greater risk for mortality.

The authors concluded that nearly 50% of DFU patients died within 5 years, making the disease's overall death rate significantly. The two main causes of death were infections and cardiovascular diseases, they added.

REFERENCE

Chen, L., Sun, S., Gao, Y. and Ran, X. (2022), Global mortality of diabetic foot ulcer: a systematic review and meta-analysis of observational studies. Diabetes Obes Metab. Accepted Author Manuscript. https://doi.org/10.1111/dom.14840