Foot ulceration and its association with mortality in diabetes mellitus: a meta-analysis.
Journal
Diabetic medicine : a journal of the British Diabetic Association
ISSN: 1464-5491
Titre abrégé: Diabet Med
Pays: England
ID NLM: 8500858
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
accepted:
14
10
2019
pubmed:
16
10
2019
medline:
26
2
2021
entrez:
16
10
2019
Statut:
ppublish
Résumé
Diabetic foot ulcers portend an almost twofold increase in all-cause mortality compared with diabetes on its own. To investigate the association between diabetic foot ulcers and risk of death. We performed a meta-analysis of all observational studies investigating the association between diabetic foot ulcers and all-cause mortality. Risk ratios and risk differences were pooled in a random-effects model. The I Altogether, we identified 11 studies that reported 84 131 deaths from any cause in 446 916 participants with diabetes during a total of 643 499 person-years of follow-up. The crude event rate for all-cause mortality in individuals with diabetes who did not develop foot ulceration was 22% lower at 181.5 deaths (per 1000 person-years) than in those who developed foot ulcers (230.8 per 1000 person-years). Diabetic foot ulceration was associated with an increased risk of all-cause mortality (pooled relative risk 2.45, 95% CI 1.85-2.85). We did not observe any tangible differences in risk of all-cause mortality from diagnosis in studies reporting a mean duration of follow-up of ≤3 years (relative risk 2.43, 95% CI 2.27-2.61) or >3 years (relative risk 2.26, 95% CI 2.13-2.40) years. Funnel plot inspection revealed no significant publication bias among studies included in this meta-analysis. Our study shows an excess rate of all-cause mortality in people with diabetic foot ulceration when compared to those without foot ulceration. It is imperative that early interventions to prevent foot ulceration and modify cardiovascular disease risk factors are put in place to reduce excess mortality.
Sections du résumé
BACKGROUND
Diabetic foot ulcers portend an almost twofold increase in all-cause mortality compared with diabetes on its own.
AIM
To investigate the association between diabetic foot ulcers and risk of death.
METHODS
We performed a meta-analysis of all observational studies investigating the association between diabetic foot ulcers and all-cause mortality. Risk ratios and risk differences were pooled in a random-effects model. The I
RESULTS
Altogether, we identified 11 studies that reported 84 131 deaths from any cause in 446 916 participants with diabetes during a total of 643 499 person-years of follow-up. The crude event rate for all-cause mortality in individuals with diabetes who did not develop foot ulceration was 22% lower at 181.5 deaths (per 1000 person-years) than in those who developed foot ulcers (230.8 per 1000 person-years). Diabetic foot ulceration was associated with an increased risk of all-cause mortality (pooled relative risk 2.45, 95% CI 1.85-2.85). We did not observe any tangible differences in risk of all-cause mortality from diagnosis in studies reporting a mean duration of follow-up of ≤3 years (relative risk 2.43, 95% CI 2.27-2.61) or >3 years (relative risk 2.26, 95% CI 2.13-2.40) years. Funnel plot inspection revealed no significant publication bias among studies included in this meta-analysis.
CONCLUSIONS
Our study shows an excess rate of all-cause mortality in people with diabetic foot ulceration when compared to those without foot ulceration. It is imperative that early interventions to prevent foot ulceration and modify cardiovascular disease risk factors are put in place to reduce excess mortality.
Types de publication
Journal Article
Meta-Analysis
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
211-218Informations de copyright
© 2019 Diabetes UK.
Références
National Institute for Health and Care Excellence (NICE). Diabetic foot problems: prevention and management. NICE guideline [NG19]. London: NICE, 2016.
Tuttolomondo A, Maida C, Pinto A. Diabetic foot syndrome as a possible cardiovascular marker in diabetic patients. J Diabetes Res 2015; 2015: 268390.
Jupiter DC, Thorud JC, Buckley CJ, Shibuya N. The impact of foot ulceration and amputation on mortality in diabetic patients. I: From ulceration to death, a systematic review. Int Wound J 2016; 13: 892-903.
Tuttolomondo A, Maida C, Pinto A. Diabetic foot syndrome: Immune-inflammatory features as possible cardiovascular markers in diabetes. World J Orthop 2015; 6: 62-76.
Jeyaraman K, Berhane T, Hamilton M, Chandra AP, Falhammar H. Mortality in patients with diabetic foot ulcer: a retrospective study of 513 cases from a single Centre in the Northern Territory of Australia. BMC Endocr Disord 2019; 19: 1.
Brownrigg JR, Davey J, Holt PJ, Davis WA, Thompson MM, Ray KK et al. The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis. Diabetologia 2012; 55: 2906-2912.
Dietrich I, Braga GA, de Melo FG, da Costa Silva Silva ACC. The Diabetic Foot as a Proxy for Cardiovascular Events and Mortality Review. Curr Atheroscler Rep 2017; 19:44.
Chaturvedi N, Jarrett J, Shipley MJ, Fuller JH. Socioeconomic gradient in morbidity and mortality in people with diabetes: cohort study findings from the Whitehall Study and the WHO Multinational Study of Vascular Disease in Diabetes. BMJ 1998; 316: 100-105.
Weng C, Coppini DV, Sonksen PH. Geographic and social factors are related to increased morbidity and mortality rates in diabetic patients. Diabet Med 2000; 17: 612-617.
Heald A, Lunt M, Rutter MK, Anderson SG, Cortes G, Edmonds M et al. Developing a foot ulcer risk model: what is needed to do this in a real-world primary care setting? Diabet Med 2019; 36: 1412-1416.
Anderson SG, Shoo H, Saluja S, Anderson CD, Khan A, Livingston M et al. Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort. Diabetologia 2018; 61: 959-967.
Leese GP, Feng Z, Leese RM, Dibben C, Emslie-Smith A. Impact of health-care accessibility and social deprivation on diabetes related foot disease. Diabet Med 2013; 30: 484-490.
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009; 62:1006-1012.
Ryan R; Cochrane Consumers and Communication Review Group. Heterogeneity and subgroup analyses in Cochrane Consumers and Communication Group reviews: planning the analysis at protocol stage. Available at http://cccrg.cochrane.org.uk. Last accessed 17 July 2019
Barili F, Parolari A, Kappetein PA, Freemantle N. Statistical Primer: heterogeneity, random- or fixed-effects model analyses? Interact Cardiovasc Thorac Surg 2018; 27: 317-321.
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Intervention. The Cochrane Collaboration, 2011.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088-1101.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634.
Boyko EJ, Ahroni JH, Smith DG, Davignon D. Increased mortality associated with diabetic foot ulcer. Diabet Med 1996; 13: 967-972.
Davis WA, Norman PE, Bruce DG, Davis TM. Predictors, consequences and costs of diabetes-related lower extremity amputation complicating type 2 diabetes: the Fremantle Diabetes Study. Diabetologia 2006; 49: 2634-2641.
Iversen MM, Tell GS, Riise T, Hanestad BR, Ostbye T, Graue M et al. History of foot ulcer increases mortality among individuals with diabetes: ten-year follow-up of the Nord-Trondelag Health Study, Norway. Diabetes Care 2009; 32: 2193-2199.
Junrungsee S, Kosachunhanun N, Wongthanee A, Rerkasem K. History of foot ulcers increases mortality among patients with diabetes in Northern Thailand. Diabet Med 2011; 28: 608-611.
Pham H, Armstrong DG, Harvey C, Harkless LB, Giurini JM, Veves A. Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. Diabetes Care 2000; 23: 606-611.
Pinto A, Tuttolomondo A, Di Raimondo D, Fernandez P, La Placa S, Di Gati M et al. Cardiovascular risk profile and morbidity in subjects affected by type 2 diabetes mellitus with and without diabetic foot. Metabolism 2008; 57: 676-682.
Ramsey SD, Newton K, Blough D, McCulloch DK, Sandhu N, Reiber GE et al. Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care 1999; 22: 382-387.
Sohn MW, Lee TA, Stuck RM, Frykberg RG, Budiman-Mak E. Mortality risk of Charcot arthropathy compared with that of diabetic foot ulcer and diabetes alone. Diabetes Care 2009; 32: 816-821.
Nirantharakumar K, Saeed M, Wilson I, Marshall T, Coleman JJ. In-hospital mortality and length of stay in patients with diabetes having foot disease. J Diabetes Complications 2013; 27: 454-458.
Walsh JW, Hoffstad OJ, Sullivan MO, Margolis DJ. Association of diabetic foot ulcer and death in a population-based cohort from the United Kingdom. Diabet Med 2016; 33: 1493-1498.
Jiang Y, Wang X, Xia L, Fu X, Xu Z, Ran X et al. A cohort study of diabetic patients and diabetic foot ulceration patients in China. Wound Repair Regen 2015; 23: 222-230.
Vadiveloo T, Jeffcoate W, Donnan PT, Colhoun HC, McGurnaghan S, Wild S et al. Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study. Diabetologia 2018; 61: 2590-2597.
Apelqvist J, Larsson J, Agardh CD. Long-term prognosis for diabetic patients with foot ulcers. J Intern Med 1993; 233: 485-491.
Martins-Mendes D, Monteiro-Soares M, Boyko EJ, Ribeiro M, Barata P, Lima J et al. The independent contribution of diabetic foot ulcer on lower extremity amputation and mortality risk. J Diabetes Complications 2014; 28: 632-638.
Young MJ, McCardle JE, Randall LE, Barclay JI. Improved survival of diabetic foot ulcer patients 1995-2008: possible impact of aggressive cardiovascular risk management. Diabetes Care 2008; 31: 2143-2147.
Brownrigg JR, Hughes CO, Burleigh D, Karthikesalingam A, Patterson BO, Holt PJ et al. Microvascular disease and risk of cardiovascular events among individuals with type 2 diabetes: a population-level cohort study. Lancet Diabetes Endocrinol 2016; 4: 588-597.
Kibel A, Selthofer-Relatic K, Drenjancevic I, Bacun T, Bosnjak I, Kibel D et al. Coronary microvascular dysfunction in diabetes mellitus. J Int Med Res 2017; 45: 1901-1929.
Orasanu G, Plutzky J. The pathologic continuum of diabetic vascular disease. J Am Coll Cardiol 2009; 53: S35-42.
Chammas NK, Hill RL, Edmonds ME. Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type. J Diabetes Res 2016; 2016: 2879809.
Goldfine AB, Shoelson SE. Therapeutic approaches targeting inflammation for diabetes and associated cardiovascular risk. J Clin Invest 2017; 127: 83-93.
Elliott J, Tesfaye S, Chaturvedi N, Gandhi RA, Stevens LK, Emery C et al. Large-fiber dysfunction in diabetic peripheral neuropathy is predicted by cardiovascular risk factors. Diabetes Care 2009; 32: 1896-1900.
Young MJ, Breddy JL, Veves A, Boulton AJ. The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. A prospective study. Diabetes Care 1994; 17: 557-560.
Coppini DV, Bowtell PA, Weng C, Young PJ, Sonksen PH. Showing neuropathy is related to increased mortality in diabetic patients - a survival analysis using an accelerated failure time model. J Clin Epidemiol 2000; 53: 519-523.
Ewing DJ, Campbell IW, Clarke BF. Mortality in diabetic autonomic neuropathy. Lancet 1976; 1: 601-603.
Gilmore JE, Allen JA, Hayes JR. Autonomic function in neuropathic diabetic patients with foot ulceration. Diabetes Care 1993; 16: 61-67.
Jeffcoate W. Vascular calcification and osteolysis in diabetic neuropathy-is RANK-L the missing link? Diabetologia 2004; 47: 1488-1492.
Mantey I, Hill RL, Foster AV, Wilson S, Wade JJ, Edmonds ME. Infection of foot ulcers with Staphylococcus aureus associated with increased mortality in diabetic patients. Commun Dis Public Health 2000; 3: 288-290.
Pavlov VA, Tracey KJ. Controlling inflammation: the cholinergic anti-inflammatory pathway. Biochem Soc Trans 2006; 34: 1037-1040.
Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR et al. Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int 2003; 63: 225-232.
Cusick M, Meleth AD, Agron E, Fisher MR, Reed GF, Knatterud GL et al. Associations of mortality and diabetes complications in patients with type 1 and type 2 diabetes: early treatment diabetic retinopathy study report no. 27. Diabetes Care 2005; 28: 617-625.
Australian Institute of Health and Welfare. Deaths in Australia. Available at https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/life-expectancy. Last accessed 15 November 2018.
Lavery LA, Peters EJ, Armstrong DG. What are the most effective interventions in preventing diabetic foot ulcers? Int Wound J 2008; 5: 425-433.
Lyman GH, Kuderer NM. The strengths and limitations of meta-analyses based on aggregate data. BMC Med Res Methodol 2005; 5: 14.
Jeffcoate WJ, Vileikyte L, Boyko EJ, Armstrong DG, Boulton AJM. Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers. Diabetes Care 2018; 41: 645-652.