Reulceration over a decade: Data from Germany and Czech Republic

Excellent data from our SALSAmigos Ogurtsova and coworkers show that diabetic foot ulcer recurrence is not only common– but likely. This is why we use the terms “remission” and “ulcer free days” to guide discussion and measure success.

Aims

Our aim was to comprehensively estimate the incidence of diabetic foot ulcer (DFU) recurrence and corresponding risk factors in two cohorts.

Methods

Prospective data from patients with active DFU from two diabetes centres in Germany (GER, n=222) and the Czech Republic (CZ, n=99) were analysed. Crude cumulative incidences were obtained. Additionally, time to recurrence and risk factors were investigated using multivariate Cox models.

Results

69%(154) of patients in GER and 70%(69) in CZ experienced at least one DFU recurrence; 25%(56) in DEU and 15%(15) in CZ died; 5%(11) and 9%(9) were lost to follow-up. The crude cumulative incidence in the first year was 28% in GER and 25% in CZ; 68% / 70% within ten years, and 69%/70% in 15 years. In GER, renal replacement therapy was associated with shorter time to recurrence (HR=3.71, 95%CI:1.26-10.87); no history of DFU before the index lesion with longer time to recurrence (HR=0.62,0.42-0.92). In CZ, type 2 diabetes (HR=2.57,1.18-5.62) and index ulcer treatment by minor amputation (HR=2.11,1.03-4.33) were associated with shorter time to recurrence.

Conclusions

Cumulative DFU recurrence was approximately 70% in 15 years in both cohorts. We found a significantly higher risk of future recurrence in patients having a consecutive ulcer compared with the first ever ulcer.

Keywords

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