Risk factors leading to mortality in patients with new onset diabetic foot ulcers

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 818-841-Diabetes Pathophysiology & Complications
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-831
Tunn Lin Tay*1, Joan J C Khoo2, Richard Yuan-Tud Chen1, Sylvaine Barbier3 and Jen Min Ng1
1Changi General Hospital, Singapore, Singapore, 2Changi General Hosp, Singapore, Singapore, 3Duke-NUS (Singapore)
Diabetic foot ulcers have a prevalence of 10% per year and are an important cause of mortality and morbidity in patients with diabetes mellitus. Mortality has been found to be as high as 51.7% after 6.5 years of follow-up. Quality of life is reduced, due to lifestyle constraints from treatment. We aim to determine the mortality rate and morbidity from recurrent hospitalization as well as factors correlated with these outcomes in subjects who have new onset diabetic foot ulcers.

A retrospective study of 193 new onset diabetic foot ulcer subjects and 386 type 2 diabetes mellitus matched controls with no foot ulcers attending similar diabetes services at a tertiary regional hospital in Singapore were studied and followed annually for 6 years from January 2004 to March 2010. All controls did not develop foot ulcers throughout follow-up. Yearly HbA1c, lipid profile, urine microalbumin, blood pressure and body mass index (BMI) were measured. None of the controls had foot ulcers throughout follow up. Data on hospitalisations and deaths were collected during this period.

The baseline characteristics of the cases and controls were similar, with males making up 58% of the cohort. There was a significantly higher all-cause mortality rate in cases with diabetic foot ulcers compared to controls (7% vs 3% after 6 years, HR 3.5, p=0.02) although cardiovascular mortality was similar in both groups (14% vs 8%, p=0.22). This was despite no difference in trends seen in HbA1c, lipid profile and blood pressure between the two groups. The only metabolic parameter of significant difference was that of increasing BMI from 26.0 kg/m2 to 30.5 kg/m2 compared to the controls with mean baseline BMI of 26 kg/m2 increasing to 27 kg/m2during follow-up (5.5% in cases vs 1.4% in controls, p=0.01). Median time from development of foot ulcers to death was 2.8 years. Older age (HR 1.07, p=0.002) and female sex (HR 3.88, p=0.039) were significant predictors for reduced life expectancy.

Rate of cardiovascular related hospital admissions was higher in subjects with diabetic foot ulcers. 16% of cases had at least 1 admission compared to 4% in controls (p=0.01) and were admitted 1.93 times over 6 years compared to once only in controls (p<0.001).

Patients with new onset diabetic foot ulcers had a higher mortality and had more frequent cardiovascular related admissions. This was especially true for the elderly and female patients suggesting more aggressive treatment of comorbidities and cardiovascular risk factors should be instituted.

Nothing to Disclose: TLT, JJCK, RYTC, SB, JMN

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm