title: History of foot ulcer increases mortality among individuals with diabetes: ten-year follow-up of the Nord-Trøndelag Health Study, Norway.
abstract: OBJECTIVE
  To compare mortality rates for individuals with diabetes with and without a history of foot ulcer (HFU) and with that for the nondiabetic population.
  
  
  METHODS
  This population-based study included 155 diabetic individuals with an HFU, 1,339 diabetic individuals without an HFU, and 63,632 nondiabetic individuals who were all followed for 10 years with mortality as the end point.
  
  
  RESULTS
  During the follow-up period, a total of 49.0% of diabetic individuals with an HFU died, compared with 35.2% of diabetic individuals without an HFU and 10.5% of those without diabetes. In Cox regression analyses adjusted for age, sex, education, current smoking, and waist circumference, having an HFU was associated with more than a twofold (2.29 [95% CI 1.82-2.88]) hazard risk for mortality compared with that of the nondiabetic group. In corresponding analyses comparing diabetic individuals with and without an HFU, an HFU was associated with 47% increased mortality (1.47 [1.14-1.89]). Significant covariates were older age, male sex, and current smoking. After inclusion of A1C, insulin use, microalbuminuria, cardiovascular disease, and depression scores in the model, each was significantly related to life expectancy.
  
  
  CONCLUSIONS
  AN HFU increased mortality risk among community-dwelling adults and elderly individuals with diabetes. The excess risk persisted after adjustment for comorbidity and depression scores, indicating that close clinical monitoring might be warranted among individuals with an HFU, who may be particularly vulnerable to adverse outcomes.
authors.affiliation: Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway. marjolein.iversen@hib.no
authors.forename: Marjolein M
authors.initials: MM
authors.lastname: Iversen
authors.forename: Grethe S
authors.initials: GS
authors.lastname: Tell
authors.forename: Trond
authors.initials: T
authors.lastname: Riise
authors.forename: Berit R
authors.initials: BR
authors.lastname: Hanestad
authors.forename: Truls
authors.initials: T
authors.lastname: Østbye
authors.forename: Marit
authors.initials: M
authors.lastname: Graue
authors.forename: Kristian
authors.initials: K
authors.lastname: Midthjell
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D048909:Diabetes Complications / Q000401:mortality; D003920:Diabetes Mellitus / Q000401:mortality; D017719:Diabetic Foot / Q000097:blood / Q000401:mortality*; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D016523:Foot Ulcer / Q000097:blood / Q000209:etiology / Q000401:mortality*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D016016:Proportional Hazards Models; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000401:mortality; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin