TOPLINE:

Despite being an underrecognized issue in both clinical practice and policy, a recent study found the 3-year recurrence rate for diabetic foot ulcers (DFUs) and the reintervention rate for chronic limb-threatening ischemia to be 50% or higher, placing a substantial burden on patients, families, and health systems. These rates are similar to — and sometimes exceed — those seen for certain aggressive cancers, underscoring the need for structured surveillance and follow-up protocols.

METHODOLOGY:

• Approximately one third of patients with diabetes develop a DFU in their lifetime; half of these ulcers become infected, 20% of infected ulcers require hospitalization, and about 20% lead to amputation. Many patients with ulcers of the lower extremity also have peripheral artery disease, which increases the risk for ulcer recurrence and limb loss, highlighting the need to consider recent data on such events.
• This study estimated the 3-year recurrence rate of DFUs and the rate of endovascular reintervention for chronic limb-threatening ischemia to assess their burden on healthcare systems; because recurrence of diabetic ulcers follows remission, these rates were compared with those for similarly morbid advanced-stage cancers.
• Data on recurrence rates of DFUs were pooled from studies (eight prospective studies, one retrospective study, and nine randomized clinical trials) published through 2024; rates of reintervention for chronic limb-threatening ischemia were sourced from a trial, and recurrence rates of cancers were retrieved from National Cancer Institute and American Cancer Society reports.

TAKEAWAY:

• At 3 years, DFUs recurred in 58% of patients, and 50.1% underwent reintervention for chronic limb-threatening ischemia after endovascular therapy.
• These rates matched or at times exceeded the 3-year recurrence rates of certain common types of advanced-stage or aggressive cancers such as breast, colorectal, and prostate cancers (ranging from 10% to 50%).

IN PRACTICE:

“Despite their substantial burden on patients, families, and health systems, the high likelihood of DFU recurrence and need for CLTI [chronic limb-threatening ischemia reintervention] remain underrecognised in clinical practice and policy, partly due to the need for serial surveillance and the often subclinical presentation (asymptomatic) of early recurrence,” the authors of the study wrote.

“The data reported in this manuscript suggest that refocusing efforts to communicate this morbidity, just as we do with cancer, may help to reframe its importance to our patients, the rest of the healthcare community, and policymakers,” they added.

SOURCE:

This study was led by Natalie S. Armstrong, Johns Hopkins Bloomberg School of Public Health in Baltimore. It was published online in the International Wound Journal.

LIMITATIONS:

This study reported no specific limitations.

DISCLOSURES:

No funding source was reported for this study. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.