Congratulations to Brennan and coworkers for these sobering data.
Perhaps the reason these sobering data are so sobering is because the “hole” is a window on the “whole”. In other words, the ulcer on the foot is likely a better predictor than any of the other end organ diseases because it is an amalgam of all of those complications in one place.
Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes
Meghan B. Brennana, b, c, , , Timothy M. Hessa, b, Brian Bartlec, Jennifer M. Cooperd, Jonathan Kangb, Elbert S. Huangc, d, Maureen Smitha, Min-Woong Sohnc, e, Christopher Crnicha, b
Diabetic foot ulcers are associated with an increased risk of death. We evaluated whether ulcer severity at presentation predicts mortality.
Patients from a national, retrospective, cohort of veterans with type 2 diabetes who developed incident diabetic foot ulcers between January 1, 2006 and September 1, 2010, were followed until death or the end of the study period, January 1, 2012. Ulcers were characterized as early stage, osteomyelitis, or gangrene at presentation. Cox proportional hazard regression identified independent predictors of death, controlling for comorbidities, laboratory parameters, and healthcare utilization.
66,323 veterans were included in the cohort and followed for a mean of 27.7 months: 1-, 2-, and 5-year survival rates were 80.80%, 69.01% and 28.64%, respectively. Compared to early stage ulcers, gangrene was associated with an increased risk of mortality (HR 1.70, 95% CI 1.57–1.83, p < 0.001). The magnitude of this effect was greater than diagnosed vascular disease, i.e., coronary artery disease, peripheral arterial disease, or stroke.
Initial diabetic foot ulcer severity is a more significant predictor of subsequent mortality than coronary artery disease, peripheral arterial disease, or stroke. Unrecognized or under-estimated vascular disease and/or sepsis secondary to gangrene should be explored as possible causal explanations.
Thanks as always to Dr. Khurram Khan for spotting this intriguing study first.