foot ulceration (DFU) is associated with a nearly 2-fold increased risk for
all-cause mortality above that of diabetes alone, says a Medscape Medical News article based on a meta-analysis published in Diabetologia.
authors included 8 studies in their analysis. The studies were published
between 1996 and 2011 and reported on a total 17,830 patients with 81,116
patient-years of follow-up. Patients with both type 1 and type 2 diabetes were
included in all but 1 study, in which all patients had type 2 diabetes.
3,095 patients with DFU had a significantly longer duration of diabetes (12.72
years) compared with the 14,735 patients without DFU (7.19 years). The
prevalence of coronary artery disease was significantly higher among patients with
DFU (31.4% vs 14.7%), as was that of both hypertension (57.6% vs 35.7%) and
hypercholesterolemia (47.6% vs 11.1%).
follow-up, there were a total 3,619 deaths from any cause. The population with
DFU had a 1.89 pooled relative risk for all-cause mortality compared with the
patients with diabetes without DFU. Unadjusted rates of all-cause mortality
were 99.9 per 1,000 person-years for the population with DFU vs 41.6/1,000 in
the group with diabetes only.
analysis of 3,138 patients in 4 studies for whom information on cardiovascular
mortality was available showed that rates of fatal myocardial infarction and
fatal stroke also were higher among patients with DFU. However, the overall
proportion of deaths resulting from cardiovascular causes was almost the same
in the DFU and non-DFU groups—43.6% of the 117 DFU patients and 44.2% of the
952 diabetes-only patients.
higher mortality rate in patients with DFU may also "relate to their more
advanced stage of diabetes, with greater overall disease burden and
noncardiovascular complications of foot ulceration such as sepsis," Medscape says.