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Diabetologia. 2018 Dec;61(12):2590-2597. doi: 10.1007/s00125-018-4723-y. Epub 2018 Aug 31.

Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study.

Author information

1
Division of Population Health Sciences, Medical Research Institute, University of Dundee, The Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK. t.vadiveloo@dundee.ac.uk.
2
Nottingham University Hospitals Trust, Nottingham, UK.
3
Division of Population Health Sciences, Medical Research Institute, University of Dundee, The Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK.
4
Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
5
Usher Institute for Public Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
6
Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK.

Abstract

AIMS/HYPOTHESIS:

Our aim was to investigate amputation-free survival in people at high risk for foot ulceration in diabetes ('high-risk foot'), and to compare different subcategories of high-risk foot.

METHODS:

Overall, 17,353 people with diabetes and high-risk foot from January 2008 to December 2011 were identified from the Scotland-wide diabetes register (Scottish Care Information-Diabetes: N = 247,278). Participants were followed-up for up to 2 years from baseline and were categorised into three groups: (1) those with no previous ulcer, (2) those with an active ulcer or (3) those with a healed previous ulcer. Participants with prior minor or major amputation were excluded. Accelerated failure time models were used to compare amputation-free survival up to 2 years between the three exposure groups.

RESULTS:

The 2 year amputation-free survival rate in all people with diabetes with high-risk foot was 84.5%. In this study group, 270 people (10.0%) had an amputation and 2424 (90.0%) died during the 2 year follow-up period. People who had active and healed previous ulcers at baseline had significantly lower 2 year amputation-free survival compared with those who had no previous ulcer (both p < 0.0001). The percentage of people who died within 2 years for those with healed ulcer, active ulcer or no baseline ulcer was 22.8%, 16% and 12.1%, respectively.

CONCLUSIONS/INTERPRETATION:

In people judged to be at high risk of foot ulceration, the risk of death was up to nine times the risk of amputation. Death rates were higher for people with diabetes who had healed ulcers than for those with active ulcers. However, people with active ulcers had the highest risk of amputation.

KEYWORDS:

Amputation; Diabetes; Foot; Mortality; Ulcer

PMID:
30171278
PMCID:
PMC6223842
DOI:
10.1007/s00125-018-4723-y
[Indexed for MEDLINE]
Free PMC Article

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