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Foot Ulcers Increase Death Risk More Than Amputation Risk

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Foot Ulcers Increase Death Risk More Than Amputation Risk

In people with diabetes who develop foot ulcers, the risk of dying within a few years is greater than the risk of needing a lower-limb amputation, according to a new study published in the journal Diabetes Care — pointing to the need for overall management of cardiovascular risk factors, rather than focusing just on wound healing.

Many people with diabetes who have foot ulcers — wounds that are resistant to healing — are understandably concerned that if the problems worsens, an infection could develop that requires amputation of a toe, foot, or leg. While this is a valid concern, for the latest study, researchers at the University of Dundee in Scotland were interested in exploring just how common amputation is in people with diabetic foot ulcers — and whether the risk of dying from other diabetes-related complications, or other causes, is greater than the risk for amputation.

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The researchers looked at health records from 233,459 people with diabetes (210,064 with type 2, and 23,395 with type 1) in Scotland who were alive at the beginning of 2012, and followed them through November 2017. Out of all participants, 13,093 (5.6%) had at least one previous foot ulcer, while another 9,023 people (3.9%) developed a first-time foot ulcer during the study period. During the follow-up period, 48,995 participants (21.0%) died, and 2,866 people (1.2%) underwent a minor or major limb amputation. Overall, 21.7% of participants either died or had an amputation (including those who had an amputation before dying). This proportion was 10.7% for people with type 1 diabetes, and 22.9% for this with type 2 diabetes.

As noted in a Healio article on the study, the rate of first-time foot ulcers was 7.8 per 1,000 person years, while the rate of a new or recurring ulcer was 11.2 per 1,000 person-years during the follow-up period. Having a foot ulcer was linked to 2.09 times the risk for amputation or death in people with type 1 diabetes, and 1.65 times the risk in people with type 2 diabetes, after adjusting for other factors known to affect the risk for amputation or death.

Risk of dying after foot ulcer found to exceed risk of amputation

Among people with a history of foot ulcers, the overall survival rate during the study period was 71% for people with type 1 diabetes and 53% for those with type 2 diabetes — demonstrating that the risk of dying far exceeds the risk for amputation in this group. The researchers noted that especially for people with a history of diabetic foot ulcers, management of cardiovascular risk factors is important — and may be the best way to reduce the risk of dying. More studies are needed to demonstrate what health interventions are most effective for reducing the risk of dying in people with a history of foot ulcers.

Want to learn more about foot ulcers? Read “Diabetic Foot Ulcers: What They Are and How Can You Avoid Them?”

Quinn Phillips

Quinn Phillips

Quinn Phillips on social media

A freelance health writer and editor based in Wisconsin, Phillips has a degree from Harvard University. He is a former Editorial Assistant for Diabetes Self-Management and has years of experience covering diabetes and related health conditions. Phillips writes on a variety of topics, but is especially interested in the intersection of health and public policy.

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