Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study

Scottish Diabetes Research Network Epidemiology Group, Thenmalar Vadiveloo (Lead / Corresponding author), William Jeffcoate, Peter T. Donnan, Helen C. Colhoun, Stuart McGurnaghan, Sarah Wild, Rory McCrimmon, Graham P. Leese

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Abstract

Aims/hypothesis: Our aim was to investigate amputation-free survival in people at high risk for foot ulceration in diabetes (‘high-risk foot’), and to compare different subcategories of high-risk foot.

Methods: Overall, 17,353 people with diabetes and high-risk foot from January 2008 to December 2011 were identified from the Scotland-wide diabetes register (Scottish Care Information-Diabetes: N = 247,278). Participants were followed-up for up to 2 years from baseline and were categorised into three groups: (1) those with no previous ulcer, (2) those with an active ulcer or (3) those with a healed previous ulcer. Participants with prior minor or major amputation were excluded. Accelerated failure time models were used to compare amputation-free survival up to 2 years between the three exposure groups.

Results: The 2 year amputation-free survival rate in all people with diabetes with high-risk foot was 84.5%. In this study group, 270 people (10.0%) had an amputation and 2424 (90.0%) died during the 2 year follow-up period. People who had active and healed previous ulcers at baseline had significantly lower 2 year amputation-free survival compared with those who had no previous ulcer (both p < 0.0001). The percentage of people who died within 2 years for those with healed ulcer, active ulcer or no baseline ulcer was 22.8%, 16% and 12.1%, respectively.

Conclusions/interpretation: In people judged to be at high risk of foot ulceration, the risk of death was up to nine times the risk of amputation. Death rates were higher for people with diabetes who had healed ulcers than for those with active ulcers. However, people with active ulcers had the highest risk of amputation.
Original languageEnglish
Pages (from-to)2590-2597
Number of pages8
JournalDiabetologia
Volume61
Issue number12
Early online date31 Aug 2018
DOIs
Publication statusPublished - Dec 2018

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Amputation
Ulcer
Observational Studies
Foot
Scotland
Survival Rate
Mortality

Keywords

  • Amputation
  • Diabetes
  • Foot
  • Mortality
  • Ulcer

Cite this

Scottish Diabetes Research Network Epidemiology Group, Vadiveloo, T., Jeffcoate, W., Donnan, P. T., Colhoun, H. C., McGurnaghan, S., ... Leese, G. P. (2018). Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study. Diabetologia, 61(12), 2590-2597. https://doi.org/10.1007/s00125-018-4723-y
Scottish Diabetes Research Network Epidemiology Group ; Vadiveloo, Thenmalar ; Jeffcoate, William ; Donnan, Peter T. ; Colhoun, Helen C. ; McGurnaghan, Stuart ; Wild, Sarah ; McCrimmon, Rory ; Leese, Graham P. / Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes : a national observational study. In: Diabetologia. 2018 ; Vol. 61, No. 12. pp. 2590-2597.
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title = "Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study",
abstract = "Aims/hypothesis: Our aim was to investigate amputation-free survival in people at high risk for foot ulceration in diabetes (‘high-risk foot’), and to compare different subcategories of high-risk foot.Methods: Overall, 17,353 people with diabetes and high-risk foot from January 2008 to December 2011 were identified from the Scotland-wide diabetes register (Scottish Care Information-Diabetes: N = 247,278). Participants were followed-up for up to 2 years from baseline and were categorised into three groups: (1) those with no previous ulcer, (2) those with an active ulcer or (3) those with a healed previous ulcer. Participants with prior minor or major amputation were excluded. Accelerated failure time models were used to compare amputation-free survival up to 2 years between the three exposure groups.Results: The 2 year amputation-free survival rate in all people with diabetes with high-risk foot was 84.5{\%}. In this study group, 270 people (10.0{\%}) had an amputation and 2424 (90.0{\%}) died during the 2 year follow-up period. People who had active and healed previous ulcers at baseline had significantly lower 2 year amputation-free survival compared with those who had no previous ulcer (both p < 0.0001). The percentage of people who died within 2 years for those with healed ulcer, active ulcer or no baseline ulcer was 22.8{\%}, 16{\%} and 12.1{\%}, respectively.Conclusions/interpretation: In people judged to be at high risk of foot ulceration, the risk of death was up to nine times the risk of amputation. Death rates were higher for people with diabetes who had healed ulcers than for those with active ulcers. However, people with active ulcers had the highest risk of amputation.",
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Scottish Diabetes Research Network Epidemiology Group, Vadiveloo, T, Jeffcoate, W, Donnan, PT, Colhoun, HC, McGurnaghan, S, Wild, S, McCrimmon, R & Leese, GP 2018, 'Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study', Diabetologia, vol. 61, no. 12, pp. 2590-2597. https://doi.org/10.1007/s00125-018-4723-y

Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes : a national observational study. / Scottish Diabetes Research Network Epidemiology Group; Vadiveloo, Thenmalar (Lead / Corresponding author); Jeffcoate, William; Donnan, Peter T.; Colhoun, Helen C.; McGurnaghan, Stuart ; Wild, Sarah ; McCrimmon, Rory; Leese, Graham P.

In: Diabetologia, Vol. 61, No. 12, 12.2018, p. 2590-2597.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes

T2 - a national observational study

AU - Scottish Diabetes Research Network Epidemiology Group

AU - Vadiveloo, Thenmalar

AU - Jeffcoate, William

AU - Donnan, Peter T.

AU - Colhoun, Helen C.

AU - McGurnaghan, Stuart

AU - Wild, Sarah

AU - McCrimmon, Rory

AU - Leese, Graham P.

N1 - Funding- University of Dundee

PY - 2018/12

Y1 - 2018/12

N2 - Aims/hypothesis: Our aim was to investigate amputation-free survival in people at high risk for foot ulceration in diabetes (‘high-risk foot’), and to compare different subcategories of high-risk foot.Methods: Overall, 17,353 people with diabetes and high-risk foot from January 2008 to December 2011 were identified from the Scotland-wide diabetes register (Scottish Care Information-Diabetes: N = 247,278). Participants were followed-up for up to 2 years from baseline and were categorised into three groups: (1) those with no previous ulcer, (2) those with an active ulcer or (3) those with a healed previous ulcer. Participants with prior minor or major amputation were excluded. Accelerated failure time models were used to compare amputation-free survival up to 2 years between the three exposure groups.Results: The 2 year amputation-free survival rate in all people with diabetes with high-risk foot was 84.5%. In this study group, 270 people (10.0%) had an amputation and 2424 (90.0%) died during the 2 year follow-up period. People who had active and healed previous ulcers at baseline had significantly lower 2 year amputation-free survival compared with those who had no previous ulcer (both p < 0.0001). The percentage of people who died within 2 years for those with healed ulcer, active ulcer or no baseline ulcer was 22.8%, 16% and 12.1%, respectively.Conclusions/interpretation: In people judged to be at high risk of foot ulceration, the risk of death was up to nine times the risk of amputation. Death rates were higher for people with diabetes who had healed ulcers than for those with active ulcers. However, people with active ulcers had the highest risk of amputation.

AB - Aims/hypothesis: Our aim was to investigate amputation-free survival in people at high risk for foot ulceration in diabetes (‘high-risk foot’), and to compare different subcategories of high-risk foot.Methods: Overall, 17,353 people with diabetes and high-risk foot from January 2008 to December 2011 were identified from the Scotland-wide diabetes register (Scottish Care Information-Diabetes: N = 247,278). Participants were followed-up for up to 2 years from baseline and were categorised into three groups: (1) those with no previous ulcer, (2) those with an active ulcer or (3) those with a healed previous ulcer. Participants with prior minor or major amputation were excluded. Accelerated failure time models were used to compare amputation-free survival up to 2 years between the three exposure groups.Results: The 2 year amputation-free survival rate in all people with diabetes with high-risk foot was 84.5%. In this study group, 270 people (10.0%) had an amputation and 2424 (90.0%) died during the 2 year follow-up period. People who had active and healed previous ulcers at baseline had significantly lower 2 year amputation-free survival compared with those who had no previous ulcer (both p < 0.0001). The percentage of people who died within 2 years for those with healed ulcer, active ulcer or no baseline ulcer was 22.8%, 16% and 12.1%, respectively.Conclusions/interpretation: In people judged to be at high risk of foot ulceration, the risk of death was up to nine times the risk of amputation. Death rates were higher for people with diabetes who had healed ulcers than for those with active ulcers. However, people with active ulcers had the highest risk of amputation.

KW - Amputation

KW - Diabetes

KW - Foot

KW - Mortality

KW - Ulcer

U2 - 10.1007/s00125-018-4723-y

DO - 10.1007/s00125-018-4723-y

M3 - Article

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SP - 2590

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JO - Diabetologia

JF - Diabetologia

SN - 0012-186X

IS - 12

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Scottish Diabetes Research Network Epidemiology Group, Vadiveloo T, Jeffcoate W, Donnan PT, Colhoun HC, McGurnaghan S et al. Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study. Diabetologia. 2018 Dec;61(12):2590-2597. https://doi.org/10.1007/s00125-018-4723-y