Long-Term Prognosis of Diabetic Foot Patients and Their Limbs
OBJECTIVE There is a dearth of long-term data regarding patient and limb survival in patients with diabetic foot ulcers (DFUs). The purpose of our study was therefore to prospectively investigate the limb and person survival of DFU patients during a follow-up period of more than 10 years. RESEARCH D...
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| Published in | Diabetes care Vol. 35; no. 10; pp. 2021 - 2027 |
|---|---|
| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
01.10.2012
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| Online Access | Get full text |
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| Abstract | OBJECTIVE
There is a dearth of long-term data regarding patient and limb survival in patients with diabetic foot ulcers (DFUs). The purpose of our study was therefore to prospectively investigate the limb and person survival of DFU patients during a follow-up period of more than 10 years.
RESEARCH DESIGN AND METHODS
Two hundred forty-seven patients with DFUs and without previous major amputation consecutively presenting to a single diabetes center between June 1998 and December 1999 were included in this study and followed up until May 2011. Mean patient age was 68.8 ± 10.9 years, 58.7% were male, and 55.5% had peripheral arterial disease (PAD). Times to first major amputation and to death were analyzed with Kaplan-Meier curves and Cox multiple regression.
RESULTS
A first major amputation occurred in 38 patients (15.4%) during follow-up. All but one of these patients had evidence of PAD at inclusion in the study, and 51.4% had severe PAD [ankle-brachial pressure index ≤0.4]). Age (hazard ratio [HR] per year, 1.05 [95% CI, 1.01–1.10]), being on dialysis (3.51 [1.02–12.07]), and PAD (35.34 [4.81–259.79]) were significant predictors for first major amputation. Cumulative mortalities at years 1, 3, 5, and 10 were 15.4, 33.1, 45.8, and 70.4%, respectively. Significant predictors for death were age (HR per year, 1.08 [95% CI, 1.06–1.10]), male sex ([1.18–2.32]), chronic renal insufficiency (1.83 [1.25–2.66]), dialysis (6.43 [3.14–13.16]), and PAD (1.44 [1.05–1.98]).
CONCLUSIONS
Although long-term limb salvage in this modern series of diabetic foot patients is favorable, long-term survival remains poor, especially among patients with PAD or renal insufficiency. |
|---|---|
| AbstractList | OBJECTIVE
There is a dearth of long-term data regarding patient and limb survival in patients with diabetic foot ulcers (DFUs). The purpose of our study was therefore to prospectively investigate the limb and person survival of DFU patients during a follow-up period of more than 10 years.
RESEARCH DESIGN AND METHODS
Two hundred forty-seven patients with DFUs and without previous major amputation consecutively presenting to a single diabetes center between June 1998 and December 1999 were included in this study and followed up until May 2011. Mean patient age was 68.8 ± 10.9 years, 58.7% were male, and 55.5% had peripheral arterial disease (PAD). Times to first major amputation and to death were analyzed with Kaplan-Meier curves and Cox multiple regression.
RESULTS
A first major amputation occurred in 38 patients (15.4%) during follow-up. All but one of these patients had evidence of PAD at inclusion in the study, and 51.4% had severe PAD [ankle-brachial pressure index ≤0.4]). Age (hazard ratio [HR] per year, 1.05 [95% CI, 1.01–1.10]), being on dialysis (3.51 [1.02–12.07]), and PAD (35.34 [4.81–259.79]) were significant predictors for first major amputation. Cumulative mortalities at years 1, 3, 5, and 10 were 15.4, 33.1, 45.8, and 70.4%, respectively. Significant predictors for death were age (HR per year, 1.08 [95% CI, 1.06–1.10]), male sex ([1.18–2.32]), chronic renal insufficiency (1.83 [1.25–2.66]), dialysis (6.43 [3.14–13.16]), and PAD (1.44 [1.05–1.98]).
CONCLUSIONS
Although long-term limb salvage in this modern series of diabetic foot patients is favorable, long-term survival remains poor, especially among patients with PAD or renal insufficiency. |
| Author | Icks, Andrea Hoffmeier, Heribert Gröblinghoff, Ute Abbas, Zulfiqarali G. Morbach, Stephan Furchert, Heike Rümenapf, Gerhard Armstrong, David G. Kersten, Kerstin Klemp, Ulrike Haastert, Burkhard Bharara, Manish Roden, Thomas Klauke, Gerd-Thomas |
| Author_xml | – sequence: 1 givenname: Stephan surname: Morbach fullname: Morbach, Stephan organization: Department of Diabetes and Angiology, Marienkrankenhaus, Soest, Germany – sequence: 2 givenname: Heike surname: Furchert fullname: Furchert, Heike organization: Department of Diabetes and Angiology, Marienkrankenhaus, Soest, Germany – sequence: 3 givenname: Ute surname: Gröblinghoff fullname: Gröblinghoff, Ute organization: Department of Diabetes and Angiology, Marienkrankenhaus, Soest, Germany – sequence: 4 givenname: Heribert surname: Hoffmeier fullname: Hoffmeier, Heribert organization: Department of Diabetes and Angiology, Marienkrankenhaus, Soest, Germany – sequence: 5 givenname: Kerstin surname: Kersten fullname: Kersten, Kerstin organization: Department of Diabetes and Angiology, Marienkrankenhaus, Soest, Germany – sequence: 6 givenname: Gerd-Thomas surname: Klauke fullname: Klauke, Gerd-Thomas organization: Department of Vascular and Endovascular Surgery, Marienkrankenhaus, Soest, Germany – sequence: 7 givenname: Ulrike surname: Klemp fullname: Klemp, Ulrike organization: Department of Vascular and Endovascular Surgery, Marienkrankenhaus, Soest, Germany – sequence: 8 givenname: Thomas surname: Roden fullname: Roden, Thomas organization: Center for Diabetology, Werl, Germany – sequence: 9 givenname: Andrea surname: Icks fullname: Icks, Andrea organization: Department of Public Health, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany – sequence: 10 givenname: Burkhard surname: Haastert fullname: Haastert, Burkhard organization: mediStatistica, Neuenrade, Germany – sequence: 11 givenname: Gerhard surname: Rümenapf fullname: Rümenapf, Gerhard organization: Department of Vascular Surgery, Gefässzentrum Oberrhein, Diakonissen-Stiftungs-Krankenhaus Speyer, Mannheim, Germany – sequence: 12 givenname: Zulfiqarali G. surname: Abbas fullname: Abbas, Zulfiqarali G. organization: Department of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, Abbas Medical Centre, Dar es Salaam, Tanzania – sequence: 13 givenname: Manish surname: Bharara fullname: Bharara, Manish organization: Department of Surgery, Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona College of Medicine, Tucson, Arizona – sequence: 14 givenname: David G. surname: Armstrong fullname: Armstrong, David G. organization: Department of Surgery, Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona College of Medicine, Tucson, Arizona |
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| References | Moulik (2022031302372677100_B4) 2003; 26 Apelqvist (2022031302372677100_B2) 1993; 233 Izumi (2022031302372677100_B7) 2009; 83 Iversen (2022031302372677100_B8) 2009; 32 Gershater (2022031302372677100_B14) 2009; 52 Boyko (2022031302372677100_B21) 1996; 13 Jeffcoate (2022031302372677100_B18) 2006; 29 Izumi (2022031302372677100_B6) 2006; 29 Apelqvist (2022031302372677100_B20) 2011; 53 Chantelau (2022031302372677100_B10) 1994; 37 Prompers (2022031302372677100_B13) 2008; 51 Coppini (2022031302372677100_B28) 2000; 53 Tentolouris (2022031302372677100_B23) 2004; 7 Ghanassia (2022031302372677100_B5) 2008; 31 Subramaniam (2022031302372677100_B22) 2005; 100 2022031302372677100_B9 Faglia (2022031302372677100_B3) 2001; 24 Boulton (2022031302372677100_B1) 2005; 366 Chammas (2022031302372677100_B29) 2002; 30 Graziani (2022031302372677100_B19) 2007; 33 Winkley (2022031302372677100_B16) 2012; 55 Junrungsee (2022031302372677100_B25) 2011; 28 Morbach (2022031302372677100_B11) 2004; 21 Icks (2022031302372677100_B24) 2011; 34 Winkley (2022031302372677100_B15) 2007; 21 Young (2022031302372677100_B17) 2008; 31 Morbach (2022031302372677100_B26) 2009; 32 Morbach (2022031302372677100_B12) 2001; 24 Forsblom (2022031302372677100_B27) 1998; 41 |
| References_xml | – volume: 30 start-page: 553 year: 2002 ident: 2022031302372677100_B29 article-title: Is neuropathic ulceration the key to understanding increased mortality due to ischaemic heart disease in diabetic foot ulcer patients? A population approach using a proportionate model publication-title: J Int Med Res doi: 10.1177/147323000203000602 contributor: fullname: Chammas – volume: 32 start-page: 2193 year: 2009 ident: 2022031302372677100_B8 article-title: History of foot ulcer increases mortality among individuals with diabetes: ten-year follow-up of the Nord-Trøndelag Health Study, Norway publication-title: Diabetes Care doi: 10.2337/dc09-0651 contributor: fullname: Iversen – volume: 53 start-page: 519 year: 2000 ident: 2022031302372677100_B28 article-title: Showing neuropathy is related to increased mortality in diabetic patients - a survival analysis using an accelerated failure time model publication-title: J Clin Epidemiol doi: 10.1016/S0895-4356(99)00170-5 contributor: fullname: Coppini – volume: 28 start-page: 608 year: 2011 ident: 2022031302372677100_B25 article-title: History of foot ulcers increases mortality among patients with diabetes in Northern Thailand publication-title: Diabet Med doi: 10.1111/j.1464-5491.2011.03262.x contributor: fullname: Junrungsee – volume: 24 start-page: 78 year: 2001 ident: 2022031302372677100_B3 article-title: New ulceration, new major amputation, and survival rates in diabetic subjects hospitalized for foot ulceration from 1990 to 1993: a 6.5-year follow-up publication-title: Diabetes Care doi: 10.2337/diacare.24.1.78 contributor: fullname: Faglia – volume: 32 start-page: e100 year: 2009 ident: 2022031302372677100_B26 article-title: All-cause mortality after diabetes-related amputation in Barbados: a prospective case-control study: response to Hambleton et Al publication-title: Diabetes Care doi: 10.2337/dc09-0736 contributor: fullname: Morbach – volume: 29 start-page: 566 year: 2006 ident: 2022031302372677100_B6 article-title: Risk of reamputation in diabetic patients stratified by limb and level of amputation: a 10-year observation publication-title: Diabetes Care doi: 10.2337/diacare.29.03.06.dc05-1992 contributor: fullname: Izumi – volume: 21 start-page: 341 year: 2007 ident: 2022031302372677100_B15 article-title: Risk factors associated with adverse outcomes in a population-based prospective cohort study of people with their first diabetic foot ulcer publication-title: J Diabetes Complications doi: 10.1016/j.jdiacomp.2007.09.004 contributor: fullname: Winkley – volume: 51 start-page: 747 year: 2008 ident: 2022031302372677100_B13 article-title: Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study publication-title: Diabetologia doi: 10.1007/s00125-008-0940-0 contributor: fullname: Prompers – volume: 83 start-page: 126 year: 2009 ident: 2022031302372677100_B7 article-title: Mortality of first-time amputees in diabetics: a 10-year observation publication-title: Diabetes Res Clin Pract doi: 10.1016/j.diabres.2008.09.005 contributor: fullname: Izumi – volume: 31 start-page: 2143 year: 2008 ident: 2022031302372677100_B17 article-title: Improved survival of diabetic foot ulcer patients 1995-2008: possible impact of aggressive cardiovascular risk management publication-title: Diabetes Care doi: 10.2337/dc08-1242 contributor: fullname: Young – volume: 53 start-page: 1582 year: 2011 ident: 2022031302372677100_B20 article-title: Factors related to outcome of neuroischemic/ischemic foot ulcer in diabetic patients publication-title: J Vasc Surg doi: 10.1016/j.jvs.2011.02.006 contributor: fullname: Apelqvist – volume: 24 start-page: 1689 year: 2001 ident: 2022031302372677100_B12 article-title: Increased risk of lower-extremity amputation among Caucasian diabetic patients on dialysis publication-title: Diabetes Care doi: 10.2337/diacare.24.9.1689 contributor: fullname: Morbach – volume: 21 start-page: 91 year: 2004 ident: 2022031302372677100_B11 article-title: Regional differences in risk factors and clinical presentation of diabetic foot lesions publication-title: Diabet Med doi: 10.1046/j.1464-5491.2003.01069.x contributor: fullname: Morbach – ident: 2022031302372677100_B9 – volume: 55 start-page: 303 year: 2012 ident: 2022031302372677100_B16 article-title: Five-year follow-up of a cohort of people with their first diabetic foot ulcer: the persistent effect of depression on mortality publication-title: Diabetologia doi: 10.1007/s00125-011-2359-2 contributor: fullname: Winkley – volume: 31 start-page: 1288 year: 2008 ident: 2022031302372677100_B5 article-title: Long-term outcome and disability of diabetic patients hospitalized for diabetic foot ulcers: a 6.5-year follow-up study publication-title: Diabetes Care doi: 10.2337/dc07-2145 contributor: fullname: Ghanassia – volume: 52 start-page: 398 year: 2009 ident: 2022031302372677100_B14 article-title: Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study publication-title: Diabetologia doi: 10.1007/s00125-008-1226-2 contributor: fullname: Gershater – volume: 7 start-page: 1598 year: 2004 ident: 2022031302372677100_B23 article-title: Mortality in diabetic and nondiabetic patients after amputations performed from 1990 to 1995: a 5-year follow-up study publication-title: Diabetes Care doi: 10.2337/diacare.27.7.1598 contributor: fullname: Tentolouris – volume: 33 start-page: 453 year: 2007 ident: 2022031302372677100_B19 article-title: Vascular involvement in diabetic subjects with ischemic foot ulcer: a new morphologic categorization of disease severity publication-title: Eur J Vasc Endovasc Surg doi: 10.1016/j.ejvs.2006.11.022 contributor: fullname: Graziani – volume: 34 start-page: 1350 year: 2011 ident: 2022031302372677100_B24 article-title: Time-dependent impact of diabetes on mortality in patients after major lower extremity amputation: survival in apopulation-based 5-year cohort in Germany publication-title: Diabetes Care doi: 10.2337/dc10-2341 contributor: fullname: Icks – volume: 29 start-page: 1784 year: 2006 ident: 2022031302372677100_B18 article-title: Assessing the outcome of the management of diabetic foot ulcers using ulcer-related and person-related measures publication-title: Diabetes Care doi: 10.2337/dc06-0306 contributor: fullname: Jeffcoate – volume: 37 start-page: 223 year: 1994 ident: 2022031302372677100_B10 article-title: Ankle/arm pressure index in diabetes mellitus publication-title: Diabetologia doi: 10.1007/BF03036315 contributor: fullname: Chantelau – volume: 366 start-page: 1719 year: 2005 ident: 2022031302372677100_B1 article-title: The global burden of diabetic foot disease publication-title: Lancet doi: 10.1016/S0140-6736(05)67698-2 contributor: fullname: Boulton – volume: 100 start-page: 1241 year: 2005 ident: 2022031302372677100_B22 article-title: Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics publication-title: Anesth Analg doi: 10.1213/01.ANE.0000147705.94738.31 contributor: fullname: Subramaniam – volume: 41 start-page: 1253 year: 1998 ident: 2022031302372677100_B27 article-title: Risk factors for mortality in Type II (non-insulin-dependent) diabetes: evidence of a role for neuropathy and a protective effect of HLA-DR4 publication-title: Diabetologia doi: 10.1007/s001250051062 contributor: fullname: Forsblom – volume: 13 start-page: 967 year: 1996 ident: 2022031302372677100_B21 article-title: Increased mortality associated with diabetic foot ulcer publication-title: Diabet Med doi: 10.1002/(SICI)1096-9136(199611)13:11<967::AID-DIA266>3.0.CO;2-K contributor: fullname: Boyko – volume: 233 start-page: 485 year: 1993 ident: 2022031302372677100_B2 article-title: Long-term prognosis for diabetic patients with foot ulcers publication-title: J Intern Med doi: 10.1111/j.1365-2796.1993.tb01003.x contributor: fullname: Apelqvist – volume: 26 start-page: 491 year: 2003 ident: 2022031302372677100_B4 article-title: Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology publication-title: Diabetes Care doi: 10.2337/diacare.26.2.491 contributor: fullname: Moulik |
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There is a dearth of long-term data regarding patient and limb survival in patients with diabetic foot ulcers (DFUs). The purpose of our study was... |
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