Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study

• Published in: Diabetologia 2018-12, Vol.61 (12), p.2590-2597
• Main Authors: Vadiveloo, Thenmalar, Jeffcoate, William, Donnan, Peter T., Colhoun, Helen C., McGurnaghan, Stuart, Wild, Sarah, McCrimmon, Rory, Leese, Graham P.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Amputation; Diabetes; Diabetes mellitus; Diabetic Foot - mortality; Diabetic Foot - surgery; Feet; Female; Foot diseases; Foot Ulcer - mortality; Foot Ulcer - surgery; Human Physiology; Humans; Internal Medicine; Leg ulcers; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Observational studies; Survival; Ulcers
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-018-4723-y

Aims/hypothesis Our aim was to investigate amputation-free survival in people at high risk for foot ulceration in diabetes (‘high-risk foot’), and to compare different subcategories of high-risk foot. Methods Overall, 17,353 people with diabetes and high-risk foot from January 2008 to December 2011 were identified from the Scotland-wide diabetes register (Scottish Care Information-Diabetes: N  = 247,278). Participants were followed-up for up to 2 years from baseline and were categorised into three groups: (1) those with no previous ulcer, (2) those with an active ulcer or (3) those with a healed previous ulcer. Participants with prior minor or major amputation were excluded. Accelerated failure time models were used to compare amputation-free survival up to 2 years between the three exposure groups. Results The 2 year amputation-free survival rate in all people with diabetes with high-risk foot was 84.5%. In this study group, 270 people (10.0%) had an amputation and 2424 (90.0%) died during the 2 year follow-up period. People who had active and healed previous ulcers at baseline had significantly lower 2 year amputation-free survival compared with those who had no previous ulcer (both p