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Paisey RB, Abbott A, Paisey CF, Walker D. Diabetic foot ulcer incidence and survival with improved diabetic foot services: an 18-year study. Diabet Med 2019; 36:1424-1430. [PMID: 31150130 PMCID: PMC6852104 DOI: 10.1111/dme.14045] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2019] [Indexed: 02/06/2023]
Abstract
AIMS To ascertain the effects of improvements in diabetic foot services over 18 years on incidence of diabetic foot ulceration. We also compared survival time from first ulcer development with presence of neuropathy, peripheral vascular disease, age and healing. METHODS Persons with new ulceration and those at high risk of ulcer development were referred to community podiatry from 1998. Their details were recorded, with verbal consent, on a central database. The effects of neuropathy, peripheral vascular disease, healing and age on survival were analysed by Cox proportional hazards ratios. RESULTS The incidence of first ulcer presentation decreased from 11.1 to 6.1 per 1000 persons between 2003 to 2017 (P <0.0001). Recurrent ulceration incidence remained stable. Prevalence of chronic and new foot ulceration combined increased from 20.7 to 33.1 per 1000 persons (P <0.0001). Ten-year survival was 85% for persons presenting with first ulcer and aged < 65 years, 50% for those aged 65-74 years and 25% for those aged 75-81 years (P < 0.0001). In those with peripheral vascular disease 5-year survival was 35% (P <0.001). CONCLUSIONS Integrated care for the diabetic foot in one National Health Service (NHS) health service area over 18 years was associated with a reduction in first presentations of diabetic foot ulceration, but failed to reduce recurrent ulceration. Cumulative prevalence of all ulcers continues to increase. Monitoring ulceration incidence can inform audit and planning of diabetic foot care services. Survival is better than reported previously in persons < 65 years and in the absence of peripheral vascular disease.
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Affiliation(s)
- R. B. Paisey
- Torbay and South Devon Integrated Care TrustTorquay
| | - A. Abbott
- Torbay and South Devon Integrated Care TrustTorquay
| | - C. F. Paisey
- West Suffolk District General HospitalBury St EdmundsUK
| | - D. Walker
- Torbay and South Devon Integrated Care TrustTorquay
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Amadou C, Carlier A, Amouyal C, Bourron O, Aubert C, Couture T, Fourniols E, Ha Van G, Rouanet S, Hartemann A. Five-year mortality in patients with diabetic foot ulcer during 2009-2010 was lower than expected. DIABETES & METABOLISM 2019; 46:230-235. [PMID: 31400509 DOI: 10.1016/j.diabet.2019.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 11/24/2022]
Abstract
AIM Mortality rates are decreasing in patients with diabetes. However, as this observation also concerns patients with diabetic foot ulcer (DFU), additional data are needed. For this reason, our study evaluated the 5-year mortality rate in patients with DFU during 2009-2010 and identified risk factors associated with mortality. METHODS Consecutive patients who attended a clinic for new DFU during 2009-2010 were followed until healing and at 1 year. Data on mortality were collected at year 5. Multivariate Cox proportional-hazards model was used to identify mortality risk factors. RESULTS A total of 347 patients were included: mean age was 65±12 years, diabetes duration was 16 [10; 27] years; 13% were on dialysis; and 7% had an organ transplant. At 5 years, 49 patients (14%) were considered lost to follow-up. Total mortality rate at 5 years was 35%, and 16% in patients with neuropathy. On multivariate analyses, mortality was positively associated with: age [hazard ratio (HR): 1.05 (1.03-1.07), P<0.0001]; duration of diabetes [HR: 1.02 (1.001-1.03], P=0.03]; PEDIS perfusion grade 2 vs. 1 [HR: 2.35 (1.28-4.29), P=0.006)]; PEDIS perfusion grade 3 vs. 1 [HR: 3.14 (1.58-6.24), P=0.001); and ulcer duration at year 1 [HR 2.09 (1.35-3.22), P=0.0009]. CONCLUSION Mortality rates were not as high as expected despite the large number of comorbidities, suggesting that progress has been made in the health management of these patients. In particular, patients with neuropathic foot ulcer had a survival rate of 84% at 5 years.
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Affiliation(s)
- C Amadou
- Diabetology department, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Carlier
- Diabetology department, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Inserm, CIC-1421, Department of Pharmacology, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France
| | - C Amouyal
- Inserm, Sorbonne-Université, Research Unit on Cardiovascular, Metabolic and Nutrition Diseases (UMRS-1166), Institute of Cardiometabolism and Nutrition, 91, boulevard de l'Hôpital, 75013 Paris, France
| | - O Bourron
- Diabetology department, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Inserm, CIC-1421, Department of Pharmacology, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France
| | - C Aubert
- Department of Internal Medicine, Fribourg Hospital, Fribourg, Switzerland
| | - T Couture
- Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France; Department of Vascular Surgery, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - E Fourniols
- Department of Orthopedic Surgery, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - G Ha Van
- Diabetology department, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Rouanet
- StatEthic SASU, 73, rue Paul-Vaillant-Couturier, 92300 Levallois-Perret, France
| | - A Hartemann
- Diabetology department, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Inserm, CIC-1421, Department of Pharmacology, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France.
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