- •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.
Diabetic foot disease and the risk of major clinical outcomes
- PMID: 37321302
- DOI: 10.1016/j.diabres.2023.110778
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.