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TOPLINE:

A history of diabetic foot events (ulcers/gangrene, amputation, or revascularization) is linked to around 50% higher all-cause mortality risk in type 2 diabetes (T2D).

METHODOLOGY:

• The study used data from the Renal Insufficiency and Cardiovascular Events cohort, an Italian multicenter study that enrolled 15,773 White patients with T2D mostly between 2006 and 2008.
• Researchers assessed the association between diabetic foot history and all-cause mortality and adjusted for confounding factors, including demographic and lifestyle factors, cardiovascular risk factors, other complications, and comorbidities.
• Data on all-cause mortality outcomes were retrieved for 15,656 patients in 2015. The mean follow-up was 7.42 ± 2.05 years. About half of the cohort had a diabetes duration of 10 years or less, and the study excluded patients on dialysis.

TAKEAWAY:

• Of the 895 patients (~6%) who reported a history of any diabetic foot event at baseline, 565 had ulcer/gangrene, amputation, or both, including 126 patients who underwent revascularization.
• The remaining 330 patients underwent revascularization without any ulcer/gangrene/amputation.
• Adjusting for confounders, a history of diabetic foot events increased the risk for all-cause death by about 50% among patients with T2D in the follow-up period (hazard ratio, 1.502; P < .0001).
• Revascularization with and without ulcer/gangrene/amputation showed only a modest increase in the adjusted risk for death, suggesting the importance of timely revascularization for reducing the risk for ulcer development and related mortality.

IN PRACTICE:

"Mortality risk was increased in patients with amputation regardless of whether it was preceded by an ulcer/gangrene, possibly suggesting a major role for infection," the authors wrote.

SOURCE:

Maria Vitale from the Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy, led this study, which was published online on January 13, 2024, in Cardiovascular Diabetology.

LIMITATIONS:

The impact of other causes of death that might be connected to diabetic foot, such as infections, as well as disparities between cardiovascular disease (CVD) and non-CVD deaths, could not be determined due to insufficient information.

The incidence of diabetic foot events and their effect on mortality may have been underestimated in this study due to inadequate information on their occurrence during follow-up. The study's findings might not apply to the general ambulatory population because only a small percentage of patients with T2D visit diabetic clinics in Italy. The observational nature of the study makes causal interpretation impossible.

DISCLOSURES:

This research was supported by the Research Foundation of the Italian Diabetes Society; the Diabetes, Endocrinology and Metabolism Foundation; and grants from Eli Lilly, Sigma-Tau, Takeda, Chiesi Farmaceutici, and Boehringer Ingelheim. The authors declared receiving lecture fees and consultant fees from several of these funders and other pharmaceutical companies.