Abstract:
OBJECTIVE:The purpose of this study was to determine whether a strategy of aggressive cardiovascular risk management reduced the mortality associated with diabetic foot ulceration. RESEARCH DESIGN AND METHODS:After an initial audit of outcomes demonstrating a high mortality rate in 404 diabetic foot ulcer patients with the first ulceration developing between 1995 and 1999, a new aggressive cardiovascular risk policy was introduced as standard practice at the Diabetic Foot Clinic, Royal Infirmary of Edinburgh, in 2001. In the first 3 years of this policy, 251 patients were screened and identified. The audit cycle was then closed by reauditing the 5-year mortality for this second group of foot ulcer patients in 2008. RESULTS:Overall 5-year mortality was reduced from 48.0% in cohort 1 to 26.8% in cohort 2 (P < 0.001). Improvement in survival was seen for both neuroischemic patients (5-year mortality of 58% reduced to 36%; relative reduction 38%) and neuropathic patients (36% reduction to 19%; relative reduction 47%) (both P < 0.001). Patients were more likely to die if they were older at the time of ulceration or had type 2 diabetes, renal impairment, or preexisting cardiovascular disease or were already taking aspirin. Prior statin use, current smoker or ex-smoker status, blood pressure, A1C, and total cholesterol were not significantly different between survivors and those who died in the follow-up periods. CONCLUSIONS:Diabetic foot ulcer patients have a high risk of death. Survival has improved over the past 13 years. The adoption of an aggressive cardiovascular risk management policy in diabetic foot ulcer clinics is recommended for these patients.
journal_name
Diabetes Carejournal_title
Diabetes careauthors
Young MJ,McCardle JE,Randall LE,Barclay JIdoi
10.2337/dc08-1242subject
Has Abstractpub_date
2008-11-01 00:00:00pages
2143-7issue
11eissn
0149-5992issn
1935-5548pii
dc08-1242journal_volume
31pub_type
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