Allison Shelley

July 13, 2016


Lower limb vascular complications and foot ulcers significantly predict mortality in patients with diabetes, researchers reported at the American Diabetes Association 76th Scientific Sessions in New Orleans.

Diabetes increases the risk for peripheral arterial disease, neuropathy, and foot ulcer, and all of these complications have been associated with an increase in mortality, said presenter Edward Boyko, MD, from the University of Washington in Seattle. But whether there is an independent association between these lower limb complications and mortality is not known, nor is whether they predict death in the long term.

"Our objective was to conduct such a study by prospectively following 1456 diabetic veteran male primary care patients in a research clinic using Veterans Affairs national healthcare data," Dr Boyko explained.

It's heart disease that will be the more likely cause of death.

His team used multivariable Cox regression models to estimate hazard ratios for mortality. During 13,038 person-years of follow-up, 1103 deaths occurred.

At baseline and follow-up, study participants were assessed for features of diabetes, HbA1c, lifestyle, vision, foot characteristics, foot monofilament insensitivity, dorsal foot transcutaneous oximetry at 44°, previous and incident foot ulcer and amputation, ankle-brachial index, estimated glomerular filtration rate, and serum albumin level.

On multivariable analysis, mortality was not associated with amputation, neuropathy, or claudication, as previously reported by Medscape Medical News.

"These patients won't die from an amputation," said session chair Paul Kim, MD, from Georgetown University Hospital in Washington, DC.

"It's heart disease that will be the more likely cause of death," he told Medscape Medical News.

The earlier physicians identify high-risk patients, the better, Dr Kim stressed.

"Lower limb problems are very common. It's important that we identify them early before these cases escalate and get very complicated, very quickly."

Dr Boyko and Dr Kim have disclosed no relevant financial relationships.

American Diabetes Association (ADA) 76th Scientific Sessions: Abstract 144-OR/144. Presented June 11, 2016.

Follow Allison Shelley on Twitter @allishelley


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