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Long Term Outcome and Disability of Diabetic Patients Hospitalised for Diabetic Foot Ulcers: A 6.5 Year Follow-up Study.
Ghanassia E, Villon L, Thuan Dit Dieudonné JF, Boegner C, Avignon A, Sultan A. Diabetes Care. 2008 Apr 4 [Epub ahead of print]
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Objective The long-term outcome and functional status of subjects hospitalised for diabetic foot ulcers have been poorly studied and thus are the topics of this study.
Research design and methods Ninety-four consecutive diabetic subjects hospitalized for diabetic foot ulcers between January 1998 and December 2000 were prospectively followed for 79.5+/-13.3 months. We calculated rates of primary healing, new ulcers, amputations, mortality, and disability and evaluated the global therapeutic success (GTS) of foot care management as defined by the association of primary healing without recurrence or disability at the end of follow-up.
Results Follow-up was successful in 89/94 subjects (63 men/31 women, mean age 63.7+/-10.8 years). Of these, 69 (77.5%) experienced primary healing without major amputation, 39 (43.8%) underwent amputation (24 minor/15 major) and 46 died (51.7%), including 23 from cardiovascular events. Forty-two out of 69 patients who experienced primary healing (60.9%) had ulcer recurrence. At the end of the follow-up period, 25 patients (28.1%) were dependent and 40 subjects (44.9%) had achieved GTS. Multivariate analysis showed the independent role of age as a predictor of GTS (p<0.05) and of impaired renal function/albuminuria as independent predictors of healing failure, 1(st) amputation and mortality (p<0.01).
Conclusions Despite a satisfactory initial healing rate, the global long-term outcome of patients hospitalised for diabetic foot ulcers was poor. Nephropathy appears to be an important predictor of long-term outcome. Further studies are needed to establish recognised criteria for therapeutic success going beyond just the evaluation of healing rate in the management of diabetic foot ulcers.
Re: Long term outcome of hospitalised diabetic foot ulcers
Here is a press release from Reuters on this: Diabetic foot ulcers often have poor outcomes
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Although the majority of patients hospitalized because of diabetic foot ulcers initially do reasonably well, in the long-term the outcome is often poor, French researchers report in the journal Diabetes Care.
"Despite a satisfactory rate of healing," investigator Dr. Antoine Avignon told Reuters Health, "the overall prognosis of patients with diabetic foot ulcers is not satisfactory."
Avignon of Universite Montpellier 1 and colleagues came to this conclusion after following 89 patients with diabetic foot ulcers for an average of more than 6 years.
Altogether, the ulcer healed in 69 patients, who were able to avoid major amputation. However, 42 of the 69 patients had a recurrence of the ulcer, and by the end of the follow-up period, 25 patients (28.1 percent) were disabled and dependent on care.
In total, only 40 of the original 89 patients studied (44.9 percent) achieved complete therapeutic success according to the criteria employed.
Over the course of the study, 46 patients died; 23 patients died of cardiovascular causes, but 9 died from a complication of the foot ulcer. After accounting for factors that could influence the outcome, such as age, only kidney impairment was an independent predictor of mortality.
"In our opinion," concluded Antoine, "it is essential to define internationally recognized success criteria for the care of diabetic foot ulcers. Those criteria must go beyond just the evaluation of healing rates."
Re: Long term outcome of hospitalised diabetic foot ulcers
Improved survival of diabetic foot ulcer patients 1995-2008, possible impact of aggressive cardiovascular risk management.
Young MJ, McCardle JE, Randall LE, Barclay JI. Diabetes Care. 2008 Aug 12. [Epub ahead of print]
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Objectives: To determine if a strategy of aggressive cardiovascular risk management reduced the mortality associated with diabetic foot ulceration.
Research design and methods: Following an initial audit of outcomes demonstrating a high mortality rate in 404 diabetic foot ulceration patients with first ulceration developing between 1995 and 1999, a new aggressive cardiovascular risk policy was introduced as standard practice at the Diabetic Foot Clinic, Royal Infirmary of Edinburgh in 2001. 251 patients were screened and identified in the first three years of this policy. The audit cycle was then closed by re-auditing the five year mortality for a second group of foot ulcer patients in 2008.
Results: Overall five-year mortality reduced from 48.0% in cohort 1 to 26.8% in cohort 2 (p<0.001). Improvement in survival was seen for both neuroischaemic patients (five year mortality 58% to 36% relative reduction 38%) and neuropathic patients (36% to 19%, relative reduction 47%), both p<0.001. Patients were more likely to die if they were older at time of ulceration or had type 2 diabetes, renal impairment, pre-existing cardiovascular disease or were already on aspirin. Prior statin use, current or ex smoking, blood pressure, HbA1c or total cholesterol were not significantly different between survivors and those who died in the follow up periods.
Conclusions: Diabetic foot ulcer patients are at high risk of death. Survival has improved over the past 13 years. The adoption of an aggressive cardiovascular risk management policy in diabetic foot ulcer clinics is recommended for these patients.
Re: Long term outcome of hospitalised diabetic foot ulcers
Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study.
Gershater MA, Löndahl M, Nyberg P, Larsson J, Thörne J, Eneroth M, Apelqvist J. Diabetologia. 2008 Nov 27. [Epub ahead of print]
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AIMS/HYPOTHESIS: We sought to identify factors related to short-term outcome of foot ulcers in patients with diabetes treated in a multidisciplinary system until healing was achieved.
METHODS: Consecutively presenting patients with diabetes and worst foot ulcer (Wagner grade 1-5, below ankle) (n = 2,511) were prospectively followed and treated according to a standardised protocol until healing was achieved or until death. The number of patients lost to dropout was 31. The characteristics of the remaining 2,480 patients were: 1,465 men, age 68 +/- 15 years (range 18-96), type 1 diabetes 18%, type 2 diabetes 82% and insulin-treated 62%.
RESULTS: The healing rate without major amputation in surviving patients was 90.6% (n = 1,867). Sixty-five per cent (n = 1,617) were healed primarily, 9% (n = 250) after minor amputation and 8% after major amputation; 17% (n = 420) died unhealed. Out of 2,060 surviving patients, 1,007 were neuroischaemic (48.8%). In a multiple regression analysis, primary healing was related to co-morbidity, duration of diabetes, extent of peripheral vascular disease and type of ulcer. In neuropathic ulcers, deep foot infection, site of ulcer and co-morbidity were related to amputation. Amputation in neuroischaemic ulcers was related to co-morbidity, peripheral vascular disease and type of ulcer. Age, sex, duration of diabetes, neuropathy, deformity and duration of ulcer or site of ulcer did not have an evident influence on probability of amputation.
CONCLUSIONS/INTERPRETATION: Patients with diabetic foot ulcer suffer from multi-organ disease. Factors related to outcome are correspondingly complex.
Long term outcome of hospitalised diabetic foot ulcers
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