title: Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type.
abstract: Diabetic foot ulcer (DFU) patients have a greater than twofold increase in mortality compared with nonulcerated diabetic patients. We investigated (a) cause of death in DFU patients, (b) age at death, and (c) relationship between cause of death and ulcer type. This was an eleven-year retrospective study on DFU patients who attended King's College Hospital Foot Clinic and subsequently died. A control group of nonulcerated diabetic patients was matched for age and type of diabetes mellitus. The cause of death was identified from death certificates (DC) and postmortem (PM) examinations. There were 243 DFU patient deaths during this period. Ischaemic heart disease (IHD) was the major cause of death in 62.5% on PM compared to 45.7% on DC. Mean age at death from IHD on PM was 5 years lower in DFU patients compared to controls (68.2 ± 8.7 years versus 73.1 ± 8.0 years, P = 0.015). IHD as a cause of death at PM was significantly linked to neuropathic foot ulcers (OR 3.064, 95% CI 1.003-9.366, and P = 0.049). Conclusions. IHD is the major cause of premature mortality in DFU patients with the neuropathic foot ulcer patients being at a greater risk.
authors.affiliation: Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
authors.forename: N K
authors.initials: NK
authors.lastname: Chammas
authors.affiliation: Department of Medical Microbiology, King's College School of Medicine, King's Denmark Hill Campus, Bessemer Road, London SE5 9PJ, UK.
authors.forename: R L R
authors.initials: RL
authors.lastname: Hill
authors.affiliation: Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
authors.forename: M E
authors.initials: ME
authors.lastname: Edmonds
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology*; D017719:Diabetic Foot / Q000453:epidemiology* / Q000209:etiology; D003929:Diabetic Neuropathies / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007511:Ischemia / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D017202:Myocardial Ischemia / Q000401:mortality*; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology