Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes

• Published in: Journal of diabetes and its complications Vol. 31; no. 3; pp. 556 - 561
• Main Authors: Brennan, Meghan B, Hess, Timothy M, Bartle, Brian, Cooper, Jennifer M, Kang, Jonathan, Huang, Elbert S, Smith, Maureen, Sohn, Min-Woong, Crnich, Christopher
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017; Elsevier Limited
• Subjects: Blood pressure; Cardiovascular disease; Cholesterol; Coronary vessels; Diabetes; Emergency medical care; Endocrinology & Metabolism; Eye diseases; Foot diseases; Foot ulcer; Gangrene; Health care policy; Health risk assessment; Hospitalization; Kidney diseases; Leg ulcers; Mortality; Patients; Peripheral neuropathy; Stroke; Vascular disease; Veterans; mortality; foot ulcer; diabetes; gangrene; Vascular disease; Gangrene; Foot ulcer; Diabetes; Mortality
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2016.11.020

Abstract Aim Diabetic foot ulcers are associated with an increased risk of death. We evaluated whether ulcer severity at presentation predicts mortality. Methods Patients from a national, retrospective, cohort of veterans with type 2 diabetes who developed incident diabetic foot ulcers between January 1, 2006 and September 1, 2010, were followed until death or the end of the study period, January 1, 2012. Ulcers were characterized as early stage, osteomyelitis, or gangrene at presentation. Cox proportional hazard regression identified independent predictors of death, controlling for comorbidities, laboratory parameters, and healthcare utilization. Results 66,323 veterans were included in the cohort and followed for a mean of 27.7 months: 1-, 2-, and 5-year survival rates were 80.80%, 69.01% and 28.64%, respectively. Compared to early stage ulcers, gangrene was associated with an increased risk of mortality (HR 1.70, 95% CI 1.57–1.83, p < 0.001). The magnitude of this effect was greater than diagnosed vascular disease, i.e., coronary artery disease, peripheral arterial disease, or stroke. Conclusion Initial diabetic foot ulcer severity is a more significant predictor of subsequent mortality than coronary artery disease, peripheral arterial disease, or stroke. Unrecognized or under-estimated vascular disease and/or sepsis secondary to gangrene should be explored as possible causal explanations.