History of foot ulcer increased mortality in diabetes

A 10-year study has linked history of foot ulcer to elevated risk for mortality among adults with diabetes.

Results of the Nord-Trøndelag Health Study, also known as HUNT 2, revealed a more than twofold increased mortality risk for adults with diabetes and a history of foot ulcer who were followed for 10 years (HR=2.29; 95% CI, 1.82-2.88) compared with adults without diabetes (HR=1.70; 95% CI, 1.54-1.86). The association persisted after adjustment for age, sex, education, smoking status and waist circumference.

Moreover, a history of foot ulcer was also associated with a more than 40% higher mortality risk when compared with adults with diabetes, but no history of foot ulcer (HR=1.47; 95% CI, 1.14-1.89).

The excess risk for mortality was partially explained by older age, male sex, higher HbA1c level, smoking status, insulin use, microalbuminuria, cardiovascular disease and depression, according to the researchers.

The population-based study included community-dwelling adults aged 20 years or older living in Nord-Trøndelag County, Norway. Researchers enrolled 155 adults with diabetes and history of foot ulcer, 1,339 with diabetes and no history and 63,632 with no diabetes or history.

During 10 years, 49% of adults with diabetes and history of foot ulcer died compared with 35.2% with diabetes and no history and 10.5% with no diabetes or history.

The main causes of death among adults with diabetes and a history of foot ulcer were CV events (48.7%), diabetes (23.7%) and cancer (14.5%).

The number of adults with diabetes and history of foot ulcer is expected to increase over the next decade; however, many adults are expected to have limited access to multidisciplinary care, according to the researchers.

“Close clinical monitoring is warranted among individuals with a history of foot ulcer, who may be particularly vulnerable for adverse outcomes,” they concluded.

Iversen MM. Diabetes Care. 2009;32:2193-2199.