Early mortality more likely than amputation in patients with high ulceration risk
medwireNews: Patients with diabetes who are at high risk for foot ulceration are more likely to die than to require amputation, report researchers.
During an average follow-up of 22 months, 14.0% of 17,353 high-risk patients died, whereas only 1.6% required an amputation.
“The current study demonstrates that in people with diabetes who have high-risk foot, the risk of premature death was up to nine times the risk of amputation,” write Thenmalar Vadiveloo (University of Dundee, UK) and study co-authors in Diabetologia.
The team identified the patients in the national Scottish Care Information-Diabetes registry, defining high risk for amputation according to the national guidelines (SIGN Guideline 116 criteria). The cohort, which excluded people with previous amputations, included 1731 with an active ulcer and 2416 with a healed ulcer (those with both were also excluded). The patients were aged an average of 70.1 years and during follow-up 270 had an amputation and 2424 died.
Amputation rates were highest in people with active ulcers, at 2.4%, compared with 1.0% and 1.5% in those with previously healed and no previous ulcers, respectively.
“This may be because some clinicians readily choose digit amputation for toe ulcers with osteomyelitis,” suggest the researchers.
Conversely, the mortality risk was highest in people with previously healed ulcers, at 22.8% compared with 16.0% in those with an active ulcer and 12.1% in those with no previous ulcer. Consequently, the corresponding 2-year amputation-free survival rates were 76.1%, 81.6%, and 85.0%, so people with previously healed ulcers were overall worst off, despite the lower amputation rate.
Vadiveloo and team suggest the low amputation rate in patients with healed compared with no ulcers may be “because individuals in the former group die before undergoing any amputation.”
They believe this indicates “the importance of managing cardiovascular risk factors more aggressively for people with diabetes prior to and subsequent to developing foot ulcer.”
The team identified independent risk factors for death and amputation, including older age, being male, longer diabetes duration, poor glycemic control, and cardiovascular disease, “all of which were unsurprising.”
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