Long term outcomes after incident diabetic foot ulcer: Multicenter large cohort prospective study (EDI-FOCUS investigators) epidemiology of diabetic foot complications study: Epidemiology of diabetic foot complications study

Ashu Rastogi, Ghanshyam Goyal, Rajesh Kesavan, Arun Bal, Harish Kumar, Mangalanadanam, Priyatham Kamath, Edward B. Jude, David G. Armstrong, Anil Bhansali

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

Abstract

Aims: This long-term prospective study evaluated limb amputation and mortality after the first neuropathic diabetic foot ulcer (DFU). Methods: A total of 2880 patients with neuropathic DFU (DFU group) and a similar number of patients of diabetes without DFU (nDFU) matched for age and diabetes duration were prospectively assessed at five referral-centers over 14 years. Pre-defined outcome was death during follow-up. Various diabetic co-morbidities and amputation were assessed as mortality predictors. Results: Overall, 501 (17.4%) patients in DFU group died compared to 89 (3.1%) (p < 0.01) in nDFU group during a median follow-up of 7(1–14) years. The 5- and 10-year mortality was 22% and 71% in the DFU group with a median survival of 7.72 (7.37–8.08) years compared to 3% (p < 0.01) and 5% (p < 0.01) and survival of 12.6 (10.5–12.7) years (p < 0.001) in nDFU group. 29.3% patients had limb amputations. The mortality risk was independent of glycemic control [OR 1.03 (0.80–1.32; p = 0.83)]. However, diabetes duration > 10 years [OR 1.31(1.02–1.70, p = 0.035)], nephropathy [OR 1.47 (1.04–2.09, p < 0.030)], minor 1.85 (1.40–2.44; p < 0.001) or major amputation 2.96 (2.01–4.34, p < 0.001)] predicted mortality. Conclusions: Every one-in-three individual with neuropathic DFU has amputation and every sixth individual has an early demise. Prevalent nephropathy and incident amputation following DFU predicts mortality.

Original languageEnglish (US)
Article number108113
JournalDiabetes Research and Clinical Practice
Volume162
DOIs
StatePublished - Apr 2020
Externally publishedYes

Keywords

  • Diabetic foot ulcer
  • Kaplan Meir survival
  • Limb amputation
  • Mortality rate
  • Neuropathy

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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