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Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study
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...
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| Published in: | Diabetologia 2018-12, Vol.61 (12), p.2590-2597 |
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| container_end_page | 2597 |
| container_issue | 12 |
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| container_title | Diabetologia |
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| creator | Vadiveloo, Thenmalar Jeffcoate, William Donnan, Peter T. Colhoun, Helen C. McGurnaghan, Stuart Wild, Sarah McCrimmon, Rory Leese, Graham P. |
| description | 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
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| doi_str_mv | 10.1007/s00125-018-4723-y |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6223842</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2098772804</sourcerecordid><originalsourceid>FETCH-LOGICAL-c470t-67e61735fba302a87bd2c425150131ff5382bd131ad78352049d82daca515a2e3</originalsourceid><addsrcrecordid>eNp1kU9v1DAQxS0EotvCB-CCLHHhgMEex7HLoVJVUUCqxAUkbpaTTHZdsnGwnUj77fHutuWPxMGyx_N7zx49Ql4I_lZwrt8lzgUoxoVhlQbJdo_ISlQSGK_APCarfZsJU38_Iacp3XLOparqp-REcqEFaLMiy-V2mrPLPoysj4g0zXHxixuoH6nQb6SSdMIwDUhdphu_3tDo0w_ah1hWyHQeWowH_V7ReddgxvSeOjoebotTaBLG5b5Kee52z8iT3g0Jn9_tZ-Tb9YevV5_YzZePn68ub1hbaZ5ZrbEWWqq-cZKDM7rpoK1ACcWFFH2vpIGmK0fXaSMV8Oq8M9C51hXEAcozcnH0neZmi12LY45usFP0Wxd3Njhv_-6MfmPXYbE1gDQVFIPXdwYx_JwxZbv1qcVhcCOGOVng50ZrMLwq6Kt_0NswxzLygdJGgVaiUOJItTGkFLF_-Izgdp-qPaZqS6p2n6rdFc3LP6d4UNzHWAA4Aqm0xjXG30__3_UXx4GuOw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2097852751</pqid></control><display><type>article</type><title>Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study</title><source>Springer Link</source><creator>Vadiveloo, Thenmalar ; Jeffcoate, William ; Donnan, Peter T. ; Colhoun, Helen C. ; McGurnaghan, Stuart ; Wild, Sarah ; McCrimmon, Rory ; Leese, Graham P.</creator><creatorcontrib>Vadiveloo, Thenmalar ; Jeffcoate, William ; Donnan, Peter T. ; Colhoun, Helen C. ; McGurnaghan, Stuart ; Wild, Sarah ; McCrimmon, Rory ; Leese, Graham P. ; Scottish Diabetes Research Network Epidemiology Group ; on behalf of the Scottish Diabetes Research Network Epidemiology Group</creatorcontrib><description>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
< 0.0001). The percentage of people who died within 2 years for those with healed ulcer, active ulcer or no baseline ulcer was 22.8%, 16% and 12.1%, respectively.
Conclusions/interpretation
In people judged to be at high risk of foot ulceration, the risk of death was up to nine times the risk of amputation. Death rates were higher for people with diabetes who had healed ulcers than for those with active ulcers. However, people with active ulcers had the highest risk of amputation.</description><identifier>ISSN: 0012-186X</identifier><identifier>EISSN: 1432-0428</identifier><identifier>DOI: 10.1007/s00125-018-4723-y</identifier><identifier>PMID: 30171278</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>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</subject><ispartof>Diabetologia, 2018-12, Vol.61 (12), p.2590-2597</ispartof><rights>The Author(s) 2018</rights><rights>Diabetologia is a copyright of Springer, (2018). All Rights Reserved. © 2018. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-67e61735fba302a87bd2c425150131ff5382bd131ad78352049d82daca515a2e3</citedby><cites>FETCH-LOGICAL-c470t-67e61735fba302a87bd2c425150131ff5382bd131ad78352049d82daca515a2e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30171278$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vadiveloo, Thenmalar</creatorcontrib><creatorcontrib>Jeffcoate, William</creatorcontrib><creatorcontrib>Donnan, Peter T.</creatorcontrib><creatorcontrib>Colhoun, Helen C.</creatorcontrib><creatorcontrib>McGurnaghan, Stuart</creatorcontrib><creatorcontrib>Wild, Sarah</creatorcontrib><creatorcontrib>McCrimmon, Rory</creatorcontrib><creatorcontrib>Leese, Graham P.</creatorcontrib><creatorcontrib>Scottish Diabetes Research Network Epidemiology Group</creatorcontrib><creatorcontrib>on behalf of the Scottish Diabetes Research Network Epidemiology Group</creatorcontrib><title>Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study</title><title>Diabetologia</title><addtitle>Diabetologia</addtitle><addtitle>Diabetologia</addtitle><description>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
< 0.0001). The percentage of people who died within 2 years for those with healed ulcer, active ulcer or no baseline ulcer was 22.8%, 16% and 12.1%, respectively.
Conclusions/interpretation
In people judged to be at high risk of foot ulceration, the risk of death was up to nine times the risk of amputation. Death rates were higher for people with diabetes who had healed ulcers than for those with active ulcers. However, people with active ulcers had the highest risk of amputation.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Amputation</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetic Foot - mortality</subject><subject>Diabetic Foot - surgery</subject><subject>Feet</subject><subject>Female</subject><subject>Foot diseases</subject><subject>Foot Ulcer - mortality</subject><subject>Foot Ulcer - surgery</subject><subject>Human Physiology</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Leg ulcers</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metabolic Diseases</subject><subject>Middle Aged</subject><subject>Observational studies</subject><subject>Survival</subject><subject>Ulcers</subject><issn>0012-186X</issn><issn>1432-0428</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kU9v1DAQxS0EotvCB-CCLHHhgMEex7HLoVJVUUCqxAUkbpaTTHZdsnGwnUj77fHutuWPxMGyx_N7zx49Ql4I_lZwrt8lzgUoxoVhlQbJdo_ISlQSGK_APCarfZsJU38_Iacp3XLOparqp-REcqEFaLMiy-V2mrPLPoysj4g0zXHxixuoH6nQb6SSdMIwDUhdphu_3tDo0w_ah1hWyHQeWowH_V7ReddgxvSeOjoebotTaBLG5b5Kee52z8iT3g0Jn9_tZ-Tb9YevV5_YzZePn68ub1hbaZ5ZrbEWWqq-cZKDM7rpoK1ACcWFFH2vpIGmK0fXaSMV8Oq8M9C51hXEAcozcnH0neZmi12LY45usFP0Wxd3Njhv_-6MfmPXYbE1gDQVFIPXdwYx_JwxZbv1qcVhcCOGOVng50ZrMLwq6Kt_0NswxzLygdJGgVaiUOJItTGkFLF_-Izgdp-qPaZqS6p2n6rdFc3LP6d4UNzHWAA4Aqm0xjXG30__3_UXx4GuOw</recordid><startdate>20181201</startdate><enddate>20181201</enddate><creator>Vadiveloo, Thenmalar</creator><creator>Jeffcoate, William</creator><creator>Donnan, Peter T.</creator><creator>Colhoun, Helen C.</creator><creator>McGurnaghan, Stuart</creator><creator>Wild, Sarah</creator><creator>McCrimmon, Rory</creator><creator>Leese, Graham P.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20181201</creationdate><title>Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study</title><author>Vadiveloo, Thenmalar ; Jeffcoate, William ; Donnan, Peter T. ; Colhoun, Helen C. ; McGurnaghan, Stuart ; Wild, Sarah ; McCrimmon, Rory ; Leese, Graham P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-67e61735fba302a87bd2c425150131ff5382bd131ad78352049d82daca515a2e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Amputation</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetic Foot - mortality</topic><topic>Diabetic Foot - surgery</topic><topic>Feet</topic><topic>Female</topic><topic>Foot diseases</topic><topic>Foot Ulcer - mortality</topic><topic>Foot Ulcer - surgery</topic><topic>Human Physiology</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Leg ulcers</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metabolic Diseases</topic><topic>Middle Aged</topic><topic>Observational studies</topic><topic>Survival</topic><topic>Ulcers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vadiveloo, Thenmalar</creatorcontrib><creatorcontrib>Jeffcoate, William</creatorcontrib><creatorcontrib>Donnan, Peter T.</creatorcontrib><creatorcontrib>Colhoun, Helen C.</creatorcontrib><creatorcontrib>McGurnaghan, Stuart</creatorcontrib><creatorcontrib>Wild, Sarah</creatorcontrib><creatorcontrib>McCrimmon, Rory</creatorcontrib><creatorcontrib>Leese, Graham P.</creatorcontrib><creatorcontrib>Scottish Diabetes Research Network Epidemiology Group</creatorcontrib><creatorcontrib>on behalf of the Scottish Diabetes Research Network Epidemiology Group</creatorcontrib><collection>SpringerOpen</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Diabetologia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vadiveloo, Thenmalar</au><au>Jeffcoate, William</au><au>Donnan, Peter T.</au><au>Colhoun, Helen C.</au><au>McGurnaghan, Stuart</au><au>Wild, Sarah</au><au>McCrimmon, Rory</au><au>Leese, Graham P.</au><aucorp>Scottish Diabetes Research Network Epidemiology Group</aucorp><aucorp>on behalf of the Scottish Diabetes Research Network Epidemiology Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study</atitle><jtitle>Diabetologia</jtitle><stitle>Diabetologia</stitle><addtitle>Diabetologia</addtitle><date>2018-12-01</date><risdate>2018</risdate><volume>61</volume><issue>12</issue><spage>2590</spage><epage>2597</epage><pages>2590-2597</pages><issn>0012-186X</issn><eissn>1432-0428</eissn><abstract>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
< 0.0001). The percentage of people who died within 2 years for those with healed ulcer, active ulcer or no baseline ulcer was 22.8%, 16% and 12.1%, respectively.
Conclusions/interpretation
In people judged to be at high risk of foot ulceration, the risk of death was up to nine times the risk of amputation. Death rates were higher for people with diabetes who had healed ulcers than for those with active ulcers. However, people with active ulcers had the highest risk of amputation.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30171278</pmid><doi>10.1007/s00125-018-4723-y</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | Springer Link |
| 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 |
| title | Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study |
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