Study links diabetic foot ulcers with higher risk of death, heart attack and stroke

October 10, 2012

(Medical Xpress)—People with diabetes who develop foot ulcers are at more risk of dying prematurely than those without the complication, finds a new large-scale study. The researchers say the findings highlight the potential need for improved detection and management of those with diabetes and foot ulcers.

The study, which is the largest analysis of diabetes into the link between foot ulcers and the condition, is published in this month's (November) edition of the journal .

There are 3.7million people diagnosed with diabetes in the UK, including an estimated 850,000 people who have the condition but do not know it. Diabetes can damage a person's and nerves, especially if their blood sugar is poorly controlled. and in the feet makes people vulnerable to unnoticed cuts or other injuries and progress into poorly healing ulcers, or sores. In severe cases, this can lead to foot or leg amputation.

In a study of 17,830 patients with diabetes – 3,095 diagnosed with foot ulceration and 14,735 without – researchers from St George's, University of London investigated how diabetic foot ulcers affected a person's risk of dying earlier. They found that those with a history of foot ulceration had a higher death rate than those without. There were an extra 58 deaths per 1,000 people each year with .

The investigators analysed from eight studies, conducted in Europe, America, Australasia and South-East Asia, published between 2006 and 2011. The length of time the health of participants was followed for varied between an average of two and 10 years for each of the studies.

People with foot ulcers and diabetes showed more , such as , and were more likely to die from cardiovascular causes. Approximately half of the additional mortalities were due to cardiovascular disease, such as or stroke.

The cause of non-cardiovascular deaths was not studied as part of this investigation but the researchers say this is potentially linked to infections and complications of foot ulceration, such as blood poisoning.

Robert Hinchliffe from St George's, University of London, who co-led the study, said: "Our research, which is the largest and therefore most reliable study to date, shows that people with diabetes who have foot ulcers are at considerably higher risk of an earlier death compared to those patients without. We suspect that this may be due in part to the effect of infections among those with foot ulcers and the greater co-existence of cardiovascular disease and foot ulcers with diabetes although the reasons are not entirely clear."

The researchers say these results underline the importance of a two-pronged approach for people with diabetes: enhanced foot ulceration screening as early detection and treatment may help reduce some of the complications; and more intensive control of blood pressure and cholesterol among those diagnosed with foot ulcers as they are at higher cardiovascular risk.

Currently, experts already recommend that people with diabetes undertake a number of precautions to prevent foot ulcers including blood sugar control, wearing socks to prevent cuts, self-checking for abrasions and getting a complete foot examination at least once a year.

Existing guidelines to prevent include healthy diet choices, regular exercise, a medical check-up at least once a year and, often, medically prescribed drug treatment.

Professor Kausik Ray, who also co-led the study, said: "Our results warrant further investigation as to whether even greater control of risk factors such as blood pressure, blood glucose and early preventative screening can further reduce mortality among those with foot ulcers. There is likely an unmet potential to reduce deaths in this group."

Explore further: Factors ID'd in healing failure of diabetic foot ulcers

More information: Diabetologia, Volume 55, Number 11 (2012), 2906-2912, DOI: 10.1007/s00125-012-2673-3, 'The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis', J. R. W. Brownrigg, J. Davey, P. J. Holt, W. A. Davis, M. M. Thompson, K. K. Ray and R. J. Hinchliffe. http://www.springerlink.com/content/m773660227386615/

Related Stories

Factors ID'd in healing failure of diabetic foot ulcers

June 15, 2012
(HealthDay) -- Patients with diabetes whose foot ulcers fail to heal have increased inflammation and aberrant growth factor levels, according to a study published online June 11 in Diabetes.

Specialists must work together to prevent leg amputations, urge experts

April 17, 2012
A lack of cooperation between doctors is allowing the number of leg amputations to remain high, despite major advances in treatment, warn experts from Imperial College London at an international symposium at the College today. ...

Recommended for you

Personalized blood sugar goals can save diabetes patients thousands

December 11, 2017
A cost analysis by researchers at the University of Chicago Medicine shows treatment plans that set individualized blood sugar goals for diabetes patients, tailored to their age and health history, can save $13,546 in health ...

Kidney disease increases risk of diabetes, study shows

December 11, 2017
Diabetes is known to increase a person's risk of kidney disease. Now, a new study from Washington University School of Medicine in St. Louis suggests that the converse also is true: Kidney dysfunction increases the risk of ...

Type 2 diabetes is not for life

December 5, 2017
Almost half of the patients with Type 2 diabetes supported by their GPs on a weight loss programme were able to reverse their diabetes in a year, a study has found.

Skipping breakfast disrupts 'clock genes' that regulate body weight

November 30, 2017
Irregular eating habits such as skipping breakfast are often associated with obesity, type 2 diabetes, hypertension and cardiovascular disease, but the precise impact of meal times on the body's internal clock has been less ...

Type 2 diabetes has hepatic origins

November 28, 2017
Affecting as many as 650 million people worldwide, obesity has become one of the most serious global health issues. Among its detrimental effects, it increases the risk of developing metabolic conditions, and primarily type ...

Critical link between obesity and diabetes has been identified

November 28, 2017
UT Southwestern researchers have identified a major mechanism by which obesity causes type 2 diabetes, which is a common complication of being overweight that afflicts more than 30 million Americans and over 400 million ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.