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History of Foot Ulcers Predicted Higher Mortality in Diabetic Elderly
By Caroline Helwick
Elsevier Global Medical News
A history of foot ulcers is associated with an increased risk of mortality among community-dwelling adults and elderly people with diabetes, according to a report published online in Diabetes Care.
In this 10-year follow-up of the Nord-Trøndelag Health Study (HUNT 2), the excess risk persisted after adjustment for comorbidity and depression scores, suggesting the need for close clinical monitoring, said Marjolein M. Iversen of Bergen (Norway) University, and associates.
Previous hospital-based studies have associated diabetic foot ulcers with a doubling in mortality risk, possibly related to comorbid disease or depression, but large population-based studies have not been conducted. The Norwegian HUNT 2 study included 155 diabetic persons with a history of foot ulcers, 1,339 diabetic persons without a history of foot ulcers, and 63,632 nondiabetic persons, followed for 10 years with mortality as the end point (Diabetes Care 2009 Sept. 3 [doi: 10.2337/dc09-0651]).
A total of 49% of diabetic persons with a history of foot ulcers died, compared with 35% of diabetic persons without a history of foot ulcers and 11% of those without diabetes.
In a Cox regression analyses adjusting for age, sex, education, current smoking status, and waist circumference, having a history of foot ulcers was associated with more than a twofold (2.29 [95% CI 1.82-2.88]) hazard risk for mortality, compared with those in the nondiabetic group, and a 47% increase in mortality, compared with diabetic persons without a history of foot ulcers (95% CI 1.14-1.89).
The increased risk, compared with persons with diabetes who have no history of foot ulcers, was only partly explained by older age, male gender, higher hemoglobin A1c, current smoking, insulin use, microalbuminuria, cardiovascular disease, and depression, the investigators said.
In this 10-year follow-up of the Nord-Trøndelag Health Study (HUNT 2), the excess risk persisted after adjustment for comorbidity and depression scores, suggesting the need for close clinical monitoring, said Marjolein M. Iversen of Bergen (Norway) University, and associates.
Previous hospital-based studies have associated diabetic foot ulcers with a doubling in mortality risk, possibly related to comorbid disease or depression, but large population-based studies have not been conducted. The Norwegian HUNT 2 study included 155 diabetic persons with a history of foot ulcers, 1,339 diabetic persons without a history of foot ulcers, and 63,632 nondiabetic persons, followed for 10 years with mortality as the end point (Diabetes Care 2009 Sept. 3 [doi: 10.2337/dc09-0651]).
A total of 49% of diabetic persons with a history of foot ulcers died, compared with 35% of diabetic persons without a history of foot ulcers and 11% of those without diabetes.
In a Cox regression analyses adjusting for age, sex, education, current smoking status, and waist circumference, having a history of foot ulcers was associated with more than a twofold (2.29 [95% CI 1.82-2.88]) hazard risk for mortality, compared with those in the nondiabetic group, and a 47% increase in mortality, compared with diabetic persons without a history of foot ulcers (95% CI 1.14-1.89).
The increased risk, compared with persons with diabetes who have no history of foot ulcers, was only partly explained by older age, male gender, higher hemoglobin A1c, current smoking, insulin use, microalbuminuria, cardiovascular disease, and depression, the investigators said.
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