Diabetic foot risk classification at the time of type 2 diabetes diagnosis and subsequent risk of mortality: a population-based cohort study

Zhaonan Wang, Jonathan Hazlehurst, Anuradhaa Subramanian, Abd Tahrani, Wasim Hanif, G Neil Thomas, Pushpa Singh, Jingya Wang, Chris Sainsbury, Krishnarajah Nirantharakumar, Francesca Crowe

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Abstract

Aim: We aimed to compare the mortality of individuals at low, moderate, and high risk of diabetic foot disease (DFD) in the context of newly diagnosed type 2 diabetes, before developing active diabetic foot problem.

Methods: This was a population-based cohort study of adults with newly diagnosed type 2 diabetes utilizing IQVIA Medical Research Data. The outcome was all-cause mortality among individuals with low, moderate, and high risk of DFD, and also in those with no record of foot assessment and those who declined foot examination.

Results: Of 225,787 individuals with newly diagnosed type 2 diabetes, 34,061 (15.1%) died during the study period from January 1, 2000 to December 31, 2019. Moderate risk and high risk of DFD were associated with increased mortality risk compared to low risk of DFD (adjusted hazard ratio [aHR] 1.50, 95% CI 1.42, 1.58; aHR 2.01, 95% CI 1.84, 2.20, respectively). Individuals who declined foot examination or who had no record also had increased mortality risk of 75% and 25% vs. those at low risk of DFD, respectively (aHR 1.75, 95% CI 1.51, 2.04; aHR 1.25, 95% CI 1.20, 1.30).

Conclusion: Individuals with new-onset type 2 diabetes who had moderate to high risk of DFD were more likely to die compared to those at low risk of DFD. The associations between declined foot examination and absence of foot examinations, and increased risk of mortality further highlight the importance of assessing foot risk as it identifies not only patients at risk of diabetic foot ulceration but also mortality.
Original languageEnglish
Article number888924
Number of pages9
JournalFrontiers in Endocrinology
Volume13
DOIs
Publication statusPublished - 11 Jul 2022

Bibliographical note

Funding Information:
We thank all those who participate in the IMRD database and those who contribute to data collection and data quality assessment.

Publisher Copyright:
Copyright © 2022 Wang, Hazlehurst, Subramanian, Tahrani, Hanif, Thomas, Singh, Wang, Sainsbury, Nirantharakumar and Crowe.

Keywords

  • type 2 diabetes
  • diabetic foot risk
  • diabetic foot disease
  • mortality
  • foot risk examination

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