We are pleased to share our team’s latest publication led by super sudents Alex Hong, Ivan Luu and Brandan Deras-Guerra under the direction of Tze Woei Tan in the journal Surgery:
Hong AT, Luu IY, Deras-Guerra B, Han S, Shin L, Shih C-D, Armstrong DG, Tan T-W. “Association between frailty progression and clinical outcomes in patients with diabetic foot ulcers.” Surgery. 2025 Aug 13;186:109599. doi:10.1016/j.surg.2025.109599.
Why Frailty Matters in Limb Preservation
Frailty is increasingly recognized as a critical determinant of outcomes in people with diabetic foot ulcers (DFUs). While we know frailty is common in this population, its progression over time has not been well studied. Understanding this trajectory is key to designing proactive strategies that prevent deterioration and improve healing.
Study Design and Key Findings
Our prospective study followed 178 patients with DFUs for 12 months, using the Clinical Frailty Scale (CFS) to measure frailty at baseline and at one year.
- At baseline: 42% of patients were frail, and 58% were nonfrail.
- At 12 months:
- All frail patients remained frail.
- 25% of patients who were nonfrail at baseline developed frailty.
Factors linked with frailty or its development:
- Peripheral artery disease (PAD)
- Myocardial infarction
- Non-Hispanic ethnicity
- Nonhealing ulcers
- Revascularization procedures
- Hospitalizations for DFU-related complications
These findings emphasize that frailty is not static—many patients without baseline frailty are at risk of becoming frail over time, particularly when wound healing is complicated or hospitalizations are required.
Clinical and Research Implications
Frailty screening should be a routine part of DFU management. Identifying at-risk patients early may allow us to tailor interventions more effectively—addressing comorbidities, optimizing revascularization strategies, and intensifying preventive care.
Future studies should focus on whether targeted frailty interventions—such as nutritional support, mobility programs, and risk-factor modification—can alter the trajectory of patients with DFUs and improve outcomes.
The Team Behind the Work
This study reflects the contributions of a remarkable interdisciplinary team:
- Alexander T. Hong, MD
- Ivan Y. Luu, MD
- Brandon Deras-Guerra, MD
- Sukgu Han, MD
- Laura Shin, MD
- Chia-Ding Shih, MD
- David G. Armstrong, DPM, MD, PhD
- Tze-Woei Tan, MD, MPH
Together, our team represents a broad spectrum of surgical, vascular, and limb preservation expertise, working toward one common goal: ending preventable amputations and improving the lives of patients with diabetes worldwide.
Closing Thoughts
Frailty is common in patients with DFUs, and once present, it tends to persist. Our study demonstrates the need to monitor frailty dynamically and highlights opportunities for intervention.
