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
Aim
Diabetic foot ulcers are associated with an increased risk of death. We evaluated whether ulcer severity at presentation predicts mortality.
Methods
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.
Results
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.
Conclusion
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.
Source: Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes
David G. Armstrong, DPM, MD, PhD, 15 yrs ago, I was told that if I didn’t take diabetic medication of some sort, that I was going to die. Since then I couldn’t take diabetic medication or insulin due to “MAJOR ALLERGIES” to them all and ended taking natural supplements. Then in 2014 at diabetic specialist took me off the natural supplements and put me on diabetic meds, because he didn’t believe me, that I was allergic to diabetic meds. He prescribed 3 types of diabetic meds starting in 2015 and had reactions to all three, but the last one caused severe hives which turned into diabetic wounds all over my body. Dr. Armstrong, when someone mentions to you that they are allergic to some kind of meds, please do not tell that individual that you do not believe them and take them at their word. You see now, I’ve got to live with these wounds all over my body, that doctor doesn’t have to worry about my situation, but I do and so does the nurse who has to medicate them once a week. That’s not fair to me, to have to go through all this with no one to care for me. I’m alive and well with complications due to type 2 diabetes and am taking natural supplements once again. Thank you for listening and reading my comment. Respectfully yours, Ms. Anika Tyrone. 2017-12-31; Sunday; Happy New Year -2018. 11:14 am.
A terrific paper highlighting the impact of DFU. Perhaps health care providers will now start to recognise that prevention is not only better than cure but more cost effective. Investing in obesity prevention and other preventative strategies is surely worth as much effort as finding the optimal wound care protocols. #preventionisbetterthancure