Recurrence of Diabetic Foot Complications: A Domino Effect Leading to Lethal Consequences - Insights from a National Longitudinal Study

Abstract

Abstract Background Foot complications are common in people with diabetes mellitus (DM), leading to increased healthcare utilization, heightened mortality risk, and notable recurrence rates even after treatment. This retrospective cohort study aimed to investigate the impact of repeated occurrence of DM-related foot complications on the risk of all-cause mortality and to identify the potential risk factors associated with repeated events. Methods People with DM admitted with foot complications (ulcer, skin and soft tissue infection or osteomyelitis) from 2012 to 2014 were identified from Taiwan’s National Health Insurance Research Database, with a three-year follow-up for repeated events. We categorized the study subjects based on their cumulative number of hospital admission with foot complications. Logistic regression was conducted to explore the potential risk factors associated with repeated diabetic foot events. Kaplan-Meier curves and Cox proportional hazard models were used to examine the associations between repeated diabetic foot events and all-cause mortality. Results In this study, 28,754 eligible individuals were enrolled and classified into three groups: no repeated diabetic foot events (76.1%), one repeated event (16.0%), and two or more repeated events (7.9%). Logistic regression revealed that advanced age, males, and those with congestive heart failure, dyslipidemia, hypertension, nephropathy, retinopathy, neuropathy, peripheral vascular disease, diabetes-related preventable hospitalizations, and outpatient visits due to diabetic foot were significantly associated with repeated events of diabetic foot complications. Compared to those with no repeated events, the adjusted hazard ratio (95% CI) for all-cause mortality were 1.26 (1.19-1.34) for one repeated event and 1.36 (1.26-1.47) for two or more repeated events. Conclusions The significant association between repeated diabetic foot and elevated mortality risk highlights the critical necessity for proactive and targeted patient care within clinical practice. More research to delve into the predictive factors related to the repeated occurrence of diabetic foot is needed to provide additional insights for prevention strategies.