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Diabetic foot ulcers linked with higher risk of death, heart attack and stroke

People with diabetes who develop foot ulcers are at more risk of dying prematurely than those without the complication, a new large-scale study has found. The researchers say the findings highlight the need for improved detection and management of those with diabetes and foot ulcers.

The study, which is the largest analysis to date of the link between foot ulcers and diabetes, is published in the journalDiabetologia.

Foot cuts or injuries can go unnoticed

Diabetes can damage blood vessels and nerves, especially if blood glucose is poorly controlled. Poor circulation and nerve damage can cause cuts or other injuries to go unnoticed – which can lead to poorly healing ulcers or sores. In severe cases, this can lead to foot or leg amputation.

The researchers from St George’s, University of London investigated 17,830 patients with diabetes: 3,095 were diagnosed with foot ulceration and 14,735 without. They found that those with a history of foot ulceration had a higher death rate compared to those without. There were an extra 58 deaths per 1,000 people each year with diabetic foot ulcers.

People with foot ulcers and diabetes showed more cardiovascular risk factors, such as high blood pressure, and were more likely to die from cardiovascular causes. Approximately half of the additional deaths were due to cardiovascular disease, such as heart attack or stroke.

The cause of non-cardiovascular deaths was not examined as part of this study, but the researchers speculate that the deaths could be linked to infections and complications of foot ulceration, such as blood poisoning.

Better screening and treatment to reduce complications

This study highlights the importance of a dual approach to reducing diabetes complications: improved screening, as early detection and treatment may help reduce some of the complications; and better control of blood pressure and cholesterol among those diagnosed with foot ulcers, as they are at higher cardiovascular risk.

Foot ulcer: the most common complication of diabetes

Bridget Turner, Director of Policy and Care Improvement at Diabetes UK, said, “This is important research as it clearly shows the potentially devastating consequences of foot ulcers. We know people with diabetes are more likely to be admitted to hospital with a foot ulcer than any other complication of diabetes and more than 125 amputations are carried out each week.

Annual foot checks and self awareness of checking own feet

“The tragic thing is that up to 80 per cent of amputations are preventable if people receive the correct management. All people with diabetes should have annual foot checks and understand how to look after their own feet. Everyone should have swift access to multidisciplinary foot care teams, which have been shown to significantly reduce levels of risk.

Putting Feet First campaign

“People with diabetes who go into hospital should have their feet checked on admission and during their stay. Diabetes UK’s ‘Putting Feet First’ campaign is helping to inform healthcare professionals and the public about the importance of diabetes footcare. This is what we feel is vital – healthcare professionals telling people about their risk and what they can do to reduce it. In addition our campaign has already succeeded in getting several underperforming Primary Care Trusts to agree to provide multidisciplinary foot care teams, but we know there is still more to be done.” 

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