One third of people with diabetes will develop diabetic foot complications: Study


  • Lifetime risk of diabetic foot disease (DFD) was 33% in the general population.
  • Age, glycemic control, diabetes duration, and vascular disease were risk factors.
  • DFD was associated with amputation, cardiovascular events, major falls, and death.
  • DFD is a high-risk marker for major morbidity and mortality.

This study from our colleagues at Johns Hopkins led by Carolyn Hicks yields yet more data on how diabetic foot disease is common, complex, and costly.

Diabetic foot disease and the risk of major clinical outcomes

Michael Fang 1Jiaqi Hu 1Yein Jeon 1Kunihiro Matsushita 1Elizabeth Selvin 1Caitlin W Hicks 2

Affiliations expand


Aims: Data on the long-term consequences of diabetic foot disease (DFD) are scarce. We examined the association between DFD and major clinical outcomes in patients with diabetes in the general population.

Methods: We conducted a prospective cohort analysis of 1,428 participants with diabetes in the Atherosclerosis Risk in Communities Study. DFD and four clinical outcomes (nontraumatic lower-extremity amputation, cardiovascular disease, major fall, and death) were captured through 2018 using administrative data. We used Cox regression models to evaluate the association between incident DFD (modeled as a time-varying exposure) and the subsequent risk of clinical outcomes.

Results: During over two decades of follow-up (1996-1998 to 2018), the cumulative incidence of DFD was 33.3%. Risk factors for DFD included older age, poor glycemic control, long diabetes duration, and prevalent vascular disease (chronic kidney disease, retinopathy, cardiovascular disease). Following incident DFD, the five-year cumulative incidence of major clinical outcomes was 38.9% for mortality, 25.2% for cardiovascular disease, 14.5% for nontraumatic lower-extremity amputation, and 13.2% for major fall. DFD remained associated with all four clinical outcomes after multivariable adjustment, with hazard ratios ranging from 1.5 (cardiovascular disease) to 34.7 (lower-extremity amputation).

Conclusions: DFD is common and confers substantial risk for major morbidity and mortality.

Keywords: Diabetic foot disease; Diabetic foot infection; amputation; cardiovascular disease; falls; general population; mortality; ulcer.

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