Foot Ulcer and Risk of Lower Limb Amputation or Death in People With Diabetes: A National Population-Based Retrospective Cohort Study

• Published in: Diabetes care Vol. 45; no. 1; pp. 83 - 91
• Main Authors: Chamberlain, Rosemary C., Fleetwood, Kelly, Wild, Sarah H., Colhoun, Helen M., Lindsay, Robert S., Petrie, John R., McCrimmon, Rory J., Gibb, Fraser, Philip, Sam, Sattar, Naveed, Kennon, Brian, Leese, Graham P.
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01.01.2022
• Subjects: Amputation; Cardiovascular diseases; Cohort analysis; Cohort Studies; Deprivation; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Diabetic Foot - complications; Diabetic Foot - epidemiology; Diabetic Foot - surgery; Feet; Foot Ulcer; Health risks; Humans; Illnesses; Leg ulcers; Lower Extremity; Mental disorders; Population; Population studies; Population-based studies; Research design; Retrospective Studies; Risk analysis; Risk Factors; Survival; Ulcers; Underweight
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/dc21-1596

To describe incidence of foot ulceration and amputation-free survival associated with foot ulceration status in a national population-based cohort study of people with diabetes. The study population included 233,459 people with diabetes who were alive in Scotland on 1 January 2012 identified from the national population-based register (national prevalence 4.9%). Characteristics of patients identified from linked hospital and mortality records during follow-up to the end of November 2017 were compared by outcome. Cox regression was used to assess the association between history of foot ulcer and amputation-free survival. The population included 23,395 people with type 1 diabetes and 210,064 people with type 2 diabetes. In total there were 13,093 (5.6%) people who had a previous foot ulceration, 9,023 people who developed a first ulcer, 48,995 who died, and 2,866 who underwent minor or major amputation during follow-up. Overall incidence of first-time foot ulcers was 7.8 per 1,000 person-years (95% CI7.6-7.9) and 11.2 (11.0-11.4) for any ulcer. Risk factors for reduced amputation-free survival included social deprivation, mental illness, and being underweight in addition to conventional cardiovascular risk factors. Adjusted hazard ratios (95% CI) were 2.09 (1.89-2.31) for type 1 diabetes and 1.65 (1.60-1.70) for type 2 diabetes. The overall incidence of foot ulceration in a population-based study of people with diabetes was 11.2 per 1,000 person-years. Foot ulceration is associated with lower amputation-free survival rate, a potential measure of effectiveness of care among people with diabetes. Mental illness and social deprivation are also highlighted as risk factors.