Diabetic Foot Ulcer Outcomes Worse Than Previously Thought

Outcomes among individuals with infected diabetic foot ulcers is worse than previously thought, with 1 in 7 having to undergo partial or full foot amputation, according to the results of a recent study.

The multicenter, prospective, observational study reviewed patient data at 12 months following culture of a diabetic foot ulcer that required antibiotic therapy. Information on wound healing, ulcer recurrence, lower extremity amputation, lower extremity revascularization, and death were obtained from patients’ notes.
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Cumulative incidence of healing at 6 and 12 months was estimated and adjusted for lower extremity amputation and death.

Within 12 months, 45 of 299 participants (15.1%) had died, 136 (45.5%) had ulcers that had healed, and 13 (9.6%) had ulcers that had recurred. Lower extremity amputation occurred in 52 (17.4%) and revascularization surgery in 18 (6.0%).

Patients with an ulcer that had been present for ~2 months or more and those with a PEDIS (perfusion, extent, depth, infection, sensation) perfusion grade of 2 or more had a lower incidence of healing. Those with a single ulcer had higher incidence of healing than those with multiple ulcers.

“Clinical outcomes at 12 months for people with an infected diabetic foot ulcer are generally poor. Our data confirm the adverse prognostic effect of limb ischemia, longer ulcer duration and the presence of multiple ulcers,” the researchers concluded.

—Michael Potts

Reference:

Ndosi M, Wright-Hughes A, Brown S, et al. Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study [published online October 30, 2017]. Diabet. Med. doi: 10.1111/dme.13537