Mortality rates in people presenting with a new diabetes-related foot ulcer: a cohort study with implications for management.
Diabetes
Foot ulcer
Mortality
Journal
Diabetologia
ISSN: 1432-0428
Titre abrégé: Diabetologia
Pays: Germany
ID NLM: 0006777
Informations de publication
Date de publication:
27 Sep 2024
27 Sep 2024
Historique:
received:
01
02
2024
accepted:
09
05
2024
medline:
27
9
2024
pubmed:
27
9
2024
entrez:
27
9
2024
Statut:
aheadofprint
Résumé
People with diabetes-related foot ulcers (DFUs) have high mortality rates. This analysis assesses the impact of selected risk factors on short-term mortality using a population registered in the National Diabetes Foot Care Audit (NDFA). Mortality rates at 12, 26 and 52 weeks was assessed in people with a new DFU registered by a specialist diabetes footcare service in the NDFA in England and Wales between April 2017 and March 2022. Poisson regression models were created to explore risk factors for mortality. In 71,000 people registered with a new DFU, mortality rates at 12, 26 and 52 weeks was 4.2%, 8.2% and 14.4%, respectively. At 26 weeks, higher mortality rates was associated with older age (rate ratio 2.15; 95% CI 2.03, 2.28, for age ≥80 years vs age 65-79 years), certain ulcer characteristics (area ≥1 cm Short-term mortality rates in people with a DFU is high. Teams managing people with DFUs should consider modifying the burdensome interventions and care required to heal such ulcers so maximising the quality of residual life, rather than focusing exclusively on healing.
Identifiants
pubmed: 39331060
doi: 10.1007/s00125-024-06262-w
pii: 10.1007/s00125-024-06262-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Kerr M, Rayman G, Jeffcoate WJ (2014) Cost of diabetic foot disease to the National Health Service in England. Diabet Med 31:1498–1504. https://doi.org/10.1111/dme.12545
doi: 10.1111/dme.12545
pubmed: 24984759
Kerr M, Barron E, Chadwick P et al (2019) The cost of diabetic foot ulcers and amputations to the National Health Service in England. Diabet Med 36:995–1002. https://doi.org/10.1111/dme.13973
doi: 10.1111/dme.13973
pubmed: 31004370
Apelqvist J, Larsson J, Agardh CD (1993) Long-term prognosis for diabetic patients with foot ulcers. J Intern Med 233:485–491. https://doi.org/10.1111/j.1365-2796.1993.tb01003.x
doi: 10.1111/j.1365-2796.1993.tb01003.x
pubmed: 8501419
Young MJ, McCardle JE, Randall LE, Barclay JI (2008) Improved survival of diabetic foot ulcer patients 1995–2008: possible impact of aggressive cardiovascular risk management. Diabetes Care 31:2143–2147. https://doi.org/10.2337/dc08-1242
doi: 10.2337/dc08-1242
pubmed: 18697900
pmcid: 2571064
Walsh JW, Hoffstad OJ, Sullivan MO, Margolis DJ (2016) Association of diabetic foot ulcer and death in a population-based cohort from the United Kingdom. Diabet Med 33:1493–1498. https://doi.org/10.1111/dme.13054
doi: 10.1111/dme.13054
pubmed: 26666583
Vadiveloo T, Jeffcoate W, Donnan PT et al (2018) Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study. Diabetologia 61:2590–2597. https://doi.org/10.1007/s00125-018-4723-y
doi: 10.1007/s00125-018-4723-y
pubmed: 30171278
pmcid: 6223842
Saluja S, Anderson SG, Hambleton I et al (2020) Foot ulceration and its association with mortality in diabetes mellitus: a meta-analysis. Diabet Med 37:211–218. https://doi.org/10.1111/dme.14151
doi: 10.1111/dme.14151
pubmed: 31613404
Armstrong DG, Swerdlow MA, Armstrong AA, Conte MS, Padula WV, Bus SA (2020) Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res 13:16. https://doi.org/10.1186/s13047-020-00383-2
doi: 10.1186/s13047-020-00383-2
pubmed: 32209136
pmcid: 7092527
NHS England National Diabetes Foot Care Audit (2018) Report on the National Diabetes Foot Care Audit (NDFA) Quality Improvement Collaboratives. Available from https://digital.nhs.uk/data-and-information/clinical-audits-and-registries/national-diabetes-foot-care-audit#reports . Accessed 24 Jan 2024
Holman N, Knighton P, Wild SH et al (2021) Cohort profile: national diabetes audit for England and wales. Diabet Med 38(9):e14616. https://doi.org/10.1111/dme.14616
doi: 10.1111/dme.14616
pubmed: 34062007
NHS England (2024) Hospital Episode Statistics. Available from https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/hospital-episode-statistics . Accessed 24 Jan 2024
Health Data Research Innovation Gateway (2024) Patient Episode Database for Wales. Available from https://web.www.healthdatagateway.org/dataset/4c33a5d2-164c-41d7-9797-dc2b008cc852 . Accessed 24 Jan 2024
Ince P, Abbas ZG, Lutale JK et al (2008) Use of the SINBAD classification system and score in comparing outcome of foot ulcer management on three continents. Diabetes Care 31(5):964–967. https://doi.org/10.2337/dc07-2367
doi: 10.2337/dc07-2367
pubmed: 18299441
Ministry of Housing, Communities & Local Government (2015) English indices of deprivation 2015. Available from https://www.gov.uk/government/statistics/english-indices-of-deprivation-2015 . Accessed 7 Apr 2021
Welsh Government (2019) Welsh Index of Multiple Deprivation 2019. Available from https://www.gov.wales/welsh-index-multiple-deprivation-full-index-update-ranks-2019 . Accessed 24 Jan 2024
Payne RA, Abel GA (2012) UK indices of multiple deprivation – a way to make comparisons across constituent countries easier. Health Stat Q 53(Spring):22–37
Public Health England (2018) Technical guide – Confidence intervals. Available from https://fingertips.phe.org.uk/profile/guidance/supporting-information/PH-methods . Accessed 9 Aug 2024
Office for National Statistics (2021) National life tables – life expectancy in the UK. Available from https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/nationallifetablesunitedkingdom/2018to2020#life-expectancy-at-birth . Accessed 24 Jan 2024
Holman N, Knighton P, O’Keefe J, Wild SH, Brewster S, Price H et al (2021) Completion of annual diabetes care processes and mortality: a cohort study using the National Diabetes Audit for England and Wales. Diabetes Obes Metab 23(12):2728–2740. https://doi.org/10.1111/dom.14528
doi: 10.1111/dom.14528
pubmed: 34405512
Dunning T (2016) Integrating palliative care with usual care of diabetic foot wounds. Diabetes Metab Res Rev 32(Suppl 1):303–310. https://doi.org/10.1002/dmrr.2758
doi: 10.1002/dmrr.2758
pubmed: 26813620