446-P: Mortality in 98 Type 1 Diabetes Mellitus and Type 2 Diabetes Mellitus (DM): Foot Ulcer Location Is an Independent Risk Determinant

Abstract

We previously demonstrated(relative-risk RR, 2.45) that all-cause mortality is much higher in people with DM foot ulceration(DFU) than those without DFU. In this prospective study, we looked at factors linked to mortality after presentation with DFU. 98 individuals recruited consecutively from an NHS Multidisciplinary Foot Clinic in Spring2016 were followed for up to 48/12. Data concerning health outcomes were extracted from the electronic patient record(EPR).17 people had type 1 DM. 81 had type 2 DM. 31 were women. The mean age(range) was 62(28-90) years with maximum DM duration 45 years. Mean HbA1c was 72(95%CI: 67-77) mmol/mol. 97% had neuropathy (International Working Group on the DM Foot(IWGDF) monofilament). 62% had vascular insufficiency(Doppler studies). 69% of ulcers were forefoot and 23% of ulcers were hind foot in location.40/98 (40.8%) died in follow-up with 27% of death certificates including sepsis (not foot-related); 35% renal failure. Regression analysis indicated a 6.3 (95%CI 3.9-8.1) fold increased risk of death with hind foot ulcer, independent of age/BMI/gender/HbA1c/eGFR/total cholesterol level. We here describe a close relation between risk of sepsis/renal failure and death in people with diabetes FU with hind foot ulceration an independent risk factor, highlighting the importance of addressing all risk factors as soon as people present with DFU. Disclosure A. H. Heald: None. M. E. Edmonds: Advisory Panel; Self; Bayer, Biomonde, Molnlycke, Urgo Medical. S. G. Anderson: None. A. Robinson: Other Relationship; Self; Napp Pharmaceuticals, Speaker’s Bureau; Self; Novo Nordisk.