Foot ulceration and its association with mortality in diabetes mellitus: a meta-analysis
S. Saluja
Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
Search for more papers by this authorS. G. Anderson
Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
George Alleyne Chronic Disease Research Centre, University of the West Indies, Cavehill, Barbados
Search for more papers by this authorI. Hambleton
George Alleyne Chronic Disease Research Centre, University of the West Indies, Cavehill, Barbados
Search for more papers by this authorH. Shoo
Diabetes and Endocrine Department, Countess of Chester NHS Foundation Trust, Chester, UK
Search for more papers by this authorM. Livingston
Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK
Search for more papers by this authorE. B. Jude
Department of Diabetes and Endocrinology, Tameside Hospital NHS Foundation Trust, Ashton-under-Lyne, UK
Search for more papers by this authorM. Lunt
Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
Search for more papers by this authorG. Dunn
Department of Podiatry, East Cheshire NHS Trust, Macclesfield, UK
Search for more papers by this authorCorresponding Author
A. H. Heald
School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
Salford Royal NHS Foundation Trust, Diabetes and Endocrinology, Salford, UK
Correspondence to: Adrian H. Heald. E-mail: [email protected]Search for more papers by this authorS. Saluja
Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
Search for more papers by this authorS. G. Anderson
Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
George Alleyne Chronic Disease Research Centre, University of the West Indies, Cavehill, Barbados
Search for more papers by this authorI. Hambleton
George Alleyne Chronic Disease Research Centre, University of the West Indies, Cavehill, Barbados
Search for more papers by this authorH. Shoo
Diabetes and Endocrine Department, Countess of Chester NHS Foundation Trust, Chester, UK
Search for more papers by this authorM. Livingston
Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK
Search for more papers by this authorE. B. Jude
Department of Diabetes and Endocrinology, Tameside Hospital NHS Foundation Trust, Ashton-under-Lyne, UK
Search for more papers by this authorM. Lunt
Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
Search for more papers by this authorG. Dunn
Department of Podiatry, East Cheshire NHS Trust, Macclesfield, UK
Search for more papers by this authorCorresponding Author
A. H. Heald
School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
Salford Royal NHS Foundation Trust, Diabetes and Endocrinology, Salford, UK
Correspondence to: Adrian H. Heald. E-mail: [email protected]Search for more papers by this authorAbstract
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 I2 statistic was used to quantify heterogeneity between studies.
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.
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