Abstract
Patients with previous diabetic foot ulcer are prone to re-ulceration and (re)amputation, to various comorbidities, have significantly impaired quality of life and increased mortality. We aimed to evaluate the risk of foot related complications and mortality in a high-risk population of patients with healed diabetic foot syndrome over a decade. 91 patients with recently healed diabetic foot ulcer were invited for follow-up at 1, 6 and 11 years after inclusion. Patient characteristics at inclusion were: 40 women, 65 ± 11 years, diabetes type 1 (n = 6) or 2 (n = 85), BMI 28.5 ± 4.4 kg/m2, and HbA1c 68 ± 17 mmol/mol. Comorbidities included neuropathy (n = 91), peripheral artery disease (PAD), history of minor (n = 25) or major (n = 5, 5.5%) amputation, nephropathy (n = 40) and retinopathy (n = 53). Ulceration recurred in 71 (65%) patients, time to first recurrence was 1.8 ± 2.4 years (mean ± SD). 21 patients had to undergo (re)amputation (minor n = 19, major n = 2), time to amputation was 3.6 ± 1.9 years. Over time, 3 further major amputations were required in patients with an initial minor amputation. Thirty-three (36%) of the initially included patients completed the follow-up period of 11.0 ± 0.6 years. 58 patients (64%) died during the observational period, time to death was 5 ± 3 years in this group. We found overall high mortality of 64% throughout the follow-up period of 11 years in high-risk patients with healed diabetic foot syndrome. Presence of PAD, prior amputation and nephropathy as well as poor glycemic control were significantly predictive for death.
Highlights
Diabetic foot syndrome (DFS) is a late complication in both patients with type 1 and type 2 diabetes mellitus with a prevalence of 4 to 10%
Patients with DFS are predisposed to various comorbidities, such as peripheral artery disease (PAD), cardiovascular disease (CVD), neuropathy, retinopathy, and nephropathy, and have significantly impaired quality of life[3,9,10,11,12]
Between May 2000 and September 2001, patients with type 1 and type 2 diabetes and recently healed diabetic foot ulcer who presented at the diabetes foot clinic of the Medical University of Graz were invited to participate in the study
Summary
Diabetic foot syndrome (DFS) is a late complication in both patients with type 1 and type 2 diabetes mellitus with a prevalence of 4 to 10%. The lifetime risk of patients with diabetes mellitus to develop DFS is as high as 25%1–3. Patients with DFS are two to three times more likely to die than patients without DFS4–8. Several studies to evaluate outcomes in patients with DFS exist[4,5,14,15,16,17,18], but data on the outcome of patients with healed diabetic foot ulcer are limited. We aimed to investigate the risk of foot related complications, comorbidities and mortality in a high-risk population of patients with healed DFS over a time period of 11 years
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