Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study

Scottish Diabetes Research Network (SDRN) Epidemiology group

doi:10.1007/s00125-018-4723-y

Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study

Scottish Diabetes Research Network (SDRN) Epidemiology group

Health Services Research Unit (HSRU)

Research output: Contribution to journal › Article › peer-review

52 Citations (Scopus)

6 Downloads (Pure)

Abstract

AIMS/HYPOTHESIS: Our aim was to investigate amputation-free survival in people at high risk for foot ulceration in diabetes ('high-risk foot'), and to compare different subcategories of high-risk foot.

METHODS: Overall, 17,353 people with diabetes and high-risk foot from January 2008 to December 2011 were identified from the Scotland-wide diabetes register (Scottish Care Information-Diabetes: N = 247,278). Participants were followed-up for up to 2 years from baseline and were categorised into three groups: (1) those with no previous ulcer, (2) those with an active ulcer or (3) those with a healed previous ulcer. Participants with prior minor or major amputation were excluded. Accelerated failure time models were used to compare amputation-free survival up to 2 years between the three exposure groups.

RESULTS: The 2 year amputation-free survival rate in all people with diabetes with high-risk foot was 84.5%. In this study group, 270 people (10.0%) had an amputation and 2424 (90.0%) died during the 2 year follow-up period. People who had active and healed previous ulcers at baseline had significantly lower 2 year amputation-free survival compared with those who had no previous ulcer (both p < 0.0001). The percentage of people who died within 2 years for those with healed ulcer, active ulcer or no baseline ulcer was 22.8%, 16% and 12.1%, respectively.

CONCLUSIONS/INTERPRETATION: In people judged to be at high risk of foot ulceration, the risk of death was up to nine times the risk of amputation. Death rates were higher for people with diabetes who had healed ulcers than for those with active ulcers. However, people with active ulcers had the highest risk of amputation.

Original language	English
Pages (from-to)	2590-2597
Number of pages	8
Journal	Diabetologia
Volume	61
Issue number	12
Early online date	31 Aug 2018
DOIs	https://doi.org/10.1007/s00125-018-4723-y
Publication status	Published - 2018

Bibliographical note

Acknowledgements
Some of the data were presented as an abstract at the Diabetes UK Professional Conference in 2017.
Diabetes data for Scotland are available for analysis by members of the Scottish Diabetes Research Network (SDRN) thanks to the hard work and dedication of NHS staff across Scotland who enter the data and people and organisations (the Scottish Care Information –Diabetes Collaboration (SCI-DC) Steering Group, the Scottish Diabetes Group, the Scottish Diabetes Survey Group, the managed clinical network managers and staff in each Health Board) involved in setting up, maintaining and overseeing SCI-DC. The SDRN receives core support from the Chief Scientist’s Office at the Scottish Government Health Department.
Members of the Scottish Diabetes Research Network Epidemiology Group who do not qualify for authorship but who contributed to data collection include R. Lindsay (Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK); J. McKnight (Western General Hospital, Edinburgh, UK); S. Philip (Institute of Applied Health Sciences, University of Aberdeen, UK); Members of the Scottish
Diabetes Research Network Epidemiology Group who do not qualify for authorship but who contributed to data management include L. Blackbourn (Institute of Genetics and Molecular Medicine, University of Edinburgh, UK); B. Farran (Institute of Genetics and Molecular Medicine, University of Edinburgh, UK); D. McAllister (Institute of Health and Wellbeing, University of Glasgow, UK); P. McKeigue (Usher Institute of Population Health Sciences, University of
Edinburgh, UK); S. Read (Usher Institute of Population Health Sciences, University of Edinburgh, UK).

Keywords

Aged
Aged, 80 and over
Amputation
Diabetic Foot/mortality
Female
Foot Ulcer/mortality
Humans
Male
Middle Aged

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1007/s00125-018-4723-yLicence: CC BY

Vadiveloo-et-al-amputation-free-diabetologia-vor
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http:// creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made
Final published version, 723 KBLicence: CC BY

Cite this

@article{071055f9c1bd4846b3464e42d0df6016,

title = "Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study",

abstract = "AIMS/HYPOTHESIS: Our aim was to investigate amputation-free survival in people at high risk for foot ulceration in diabetes ('high-risk foot'), and to compare different subcategories of high-risk foot.METHODS: Overall, 17,353 people with diabetes and high-risk foot from January 2008 to December 2011 were identified from the Scotland-wide diabetes register (Scottish Care Information-Diabetes: N = 247,278). Participants were followed-up for up to 2 years from baseline and were categorised into three groups: (1) those with no previous ulcer, (2) those with an active ulcer or (3) those with a healed previous ulcer. Participants with prior minor or major amputation were excluded. Accelerated failure time models were used to compare amputation-free survival up to 2 years between the three exposure groups.RESULTS: The 2 year amputation-free survival rate in all people with diabetes with high-risk foot was 84.5%. In this study group, 270 people (10.0%) had an amputation and 2424 (90.0%) died during the 2 year follow-up period. People who had active and healed previous ulcers at baseline had significantly lower 2 year amputation-free survival compared with those who had no previous ulcer (both p < 0.0001). The percentage of people who died within 2 years for those with healed ulcer, active ulcer or no baseline ulcer was 22.8%, 16% and 12.1%, respectively.CONCLUSIONS/INTERPRETATION: In people judged to be at high risk of foot ulceration, the risk of death was up to nine times the risk of amputation. Death rates were higher for people with diabetes who had healed ulcers than for those with active ulcers. However, people with active ulcers had the highest risk of amputation.",

keywords = "Aged, Aged, 80 and over, Amputation, Diabetic Foot/mortality, Female, Foot Ulcer/mortality, Humans, Male, Middle Aged",

author = "Thenmalar Vadiveloo and William Jeffcoate and Donnan, {Peter T} and Colhoun, {Helen C} and Stuart McGurnaghan and Sarah Wild and Rory McCrimmon and Leese, {Graham P} and {Scottish Diabetes Research Network (SDRN) Epidemiology group}",

note = "Acknowledgements Some of the data were presented as an abstract at the Diabetes UK Professional Conference in 2017. Diabetes data for Scotland are available for analysis by members of the Scottish Diabetes Research Network (SDRN) thanks to the hard work and dedication of NHS staff across Scotland who enter the data and people and organisations (the Scottish Care Information –Diabetes Collaboration (SCI-DC) Steering Group, the Scottish Diabetes Group, the Scottish Diabetes Survey Group, the managed clinical network managers and staff in each Health Board) involved in setting up, maintaining and overseeing SCI-DC. The SDRN receives core support from the Chief Scientist{\textquoteright}s Office at the Scottish Government Health Department. Members of the Scottish Diabetes Research Network Epidemiology Group who do not qualify for authorship but who contributed to data collection include R. Lindsay (Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK); J. McKnight (Western General Hospital, Edinburgh, UK); S. Philip (Institute of Applied Health Sciences, University of Aberdeen, UK); Members of the Scottish Diabetes Research Network Epidemiology Group who do not qualify for authorship but who contributed to data management include L. Blackbourn (Institute of Genetics and Molecular Medicine, University of Edinburgh, UK); B. Farran (Institute of Genetics and Molecular Medicine, University of Edinburgh, UK); D. McAllister (Institute of Health and Wellbeing, University of Glasgow, UK); P. McKeigue (Usher Institute of Population Health Sciences, University of Edinburgh, UK); S. Read (Usher Institute of Population Health Sciences, University of Edinburgh, UK).",

year = "2018",

doi = "10.1007/s00125-018-4723-y",

language = "English",

volume = "61",

pages = "2590--2597",

journal = "Diabetologia",

issn = "0012-186X",

publisher = "Springer ",

number = "12",

}

TY - JOUR

T1 - Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes

T2 - a national observational study

AU - Vadiveloo, Thenmalar

AU - Jeffcoate, William

AU - Donnan, Peter T

AU - Colhoun, Helen C

AU - McGurnaghan, Stuart

AU - Wild, Sarah

AU - McCrimmon, Rory

AU - Leese, Graham P

AU - Scottish Diabetes Research Network (SDRN) Epidemiology group

N1 - Acknowledgements Some of the data were presented as an abstract at the Diabetes UK Professional Conference in 2017. Diabetes data for Scotland are available for analysis by members of the Scottish Diabetes Research Network (SDRN) thanks to the hard work and dedication of NHS staff across Scotland who enter the data and people and organisations (the Scottish Care Information –Diabetes Collaboration (SCI-DC) Steering Group, the Scottish Diabetes Group, the Scottish Diabetes Survey Group, the managed clinical network managers and staff in each Health Board) involved in setting up, maintaining and overseeing SCI-DC. The SDRN receives core support from the Chief Scientist’s Office at the Scottish Government Health Department. Members of the Scottish Diabetes Research Network Epidemiology Group who do not qualify for authorship but who contributed to data collection include R. Lindsay (Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK); J. McKnight (Western General Hospital, Edinburgh, UK); S. Philip (Institute of Applied Health Sciences, University of Aberdeen, UK); Members of the Scottish Diabetes Research Network Epidemiology Group who do not qualify for authorship but who contributed to data management include L. Blackbourn (Institute of Genetics and Molecular Medicine, University of Edinburgh, UK); B. Farran (Institute of Genetics and Molecular Medicine, University of Edinburgh, UK); D. McAllister (Institute of Health and Wellbeing, University of Glasgow, UK); P. McKeigue (Usher Institute of Population Health Sciences, University of Edinburgh, UK); S. Read (Usher Institute of Population Health Sciences, University of Edinburgh, UK).

PY - 2018

Y1 - 2018

N2 - AIMS/HYPOTHESIS: Our aim was to investigate amputation-free survival in people at high risk for foot ulceration in diabetes ('high-risk foot'), and to compare different subcategories of high-risk foot.METHODS: Overall, 17,353 people with diabetes and high-risk foot from January 2008 to December 2011 were identified from the Scotland-wide diabetes register (Scottish Care Information-Diabetes: N = 247,278). Participants were followed-up for up to 2 years from baseline and were categorised into three groups: (1) those with no previous ulcer, (2) those with an active ulcer or (3) those with a healed previous ulcer. Participants with prior minor or major amputation were excluded. Accelerated failure time models were used to compare amputation-free survival up to 2 years between the three exposure groups.RESULTS: The 2 year amputation-free survival rate in all people with diabetes with high-risk foot was 84.5%. In this study group, 270 people (10.0%) had an amputation and 2424 (90.0%) died during the 2 year follow-up period. People who had active and healed previous ulcers at baseline had significantly lower 2 year amputation-free survival compared with those who had no previous ulcer (both p < 0.0001). The percentage of people who died within 2 years for those with healed ulcer, active ulcer or no baseline ulcer was 22.8%, 16% and 12.1%, respectively.CONCLUSIONS/INTERPRETATION: In people judged to be at high risk of foot ulceration, the risk of death was up to nine times the risk of amputation. Death rates were higher for people with diabetes who had healed ulcers than for those with active ulcers. However, people with active ulcers had the highest risk of amputation.

AB - AIMS/HYPOTHESIS: Our aim was to investigate amputation-free survival in people at high risk for foot ulceration in diabetes ('high-risk foot'), and to compare different subcategories of high-risk foot.METHODS: Overall, 17,353 people with diabetes and high-risk foot from January 2008 to December 2011 were identified from the Scotland-wide diabetes register (Scottish Care Information-Diabetes: N = 247,278). Participants were followed-up for up to 2 years from baseline and were categorised into three groups: (1) those with no previous ulcer, (2) those with an active ulcer or (3) those with a healed previous ulcer. Participants with prior minor or major amputation were excluded. Accelerated failure time models were used to compare amputation-free survival up to 2 years between the three exposure groups.RESULTS: The 2 year amputation-free survival rate in all people with diabetes with high-risk foot was 84.5%. In this study group, 270 people (10.0%) had an amputation and 2424 (90.0%) died during the 2 year follow-up period. People who had active and healed previous ulcers at baseline had significantly lower 2 year amputation-free survival compared with those who had no previous ulcer (both p < 0.0001). The percentage of people who died within 2 years for those with healed ulcer, active ulcer or no baseline ulcer was 22.8%, 16% and 12.1%, respectively.CONCLUSIONS/INTERPRETATION: In people judged to be at high risk of foot ulceration, the risk of death was up to nine times the risk of amputation. Death rates were higher for people with diabetes who had healed ulcers than for those with active ulcers. However, people with active ulcers had the highest risk of amputation.

KW - Aged

KW - Aged, 80 and over

KW - Amputation

KW - Diabetic Foot/mortality

KW - Female

KW - Foot Ulcer/mortality

KW - Humans

KW - Male

KW - Middle Aged

U2 - 10.1007/s00125-018-4723-y

DO - 10.1007/s00125-018-4723-y

M3 - Article

C2 - 30171278

SN - 0012-186X

VL - 61

SP - 2590

EP - 2597

JO - Diabetologia

JF - Diabetologia

IS - 12

ER -

Amputation-free survival in 17,353 people at high risk for foot ulceration in diabetes: a national observational study

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

Fingerprint

Cite this