Diabetic 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.   

The 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.

The 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%).

During 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.

Further 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.

The 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.