Diabetic foot ulcers tied to earlier death

NEW YORK, 14 dec 2009 – Among people with diabetes, those who develop foot ulcers seem to die earlier than those without the complication, a new study finds.

Over time, diabetes can damage the blood vessels and nerves, especially if a person's blood sugar is poorly controlled. Poor circulation and nerve damage in the feet makes people vulnerable to sustaining cuts or other injuries that go unnoticed and progress into poorly healing ulcers, or sores. Severe cases can ultimately lead to amputation.

In the new study, researchers found that among more than 65,000 Norwegian adults, those with a history of diabetic foot ulcers had a higher death rate over 10 years.

Compared with other diabetic adults, those with a history of foot ulcers were 47 percent more likely to die during the study period. The risk was more than two-fold higher when foot ulcer patients were compared with non-diabetic adults.

People with a history of foot ulcers did tend to be older, have poorer blood sugar control and have higher rates of heart disease and stroke, depression and kidney dysfunction. But those factors only partly explained the higher death risk attributed to foot ulcers, the researchers report in the journal Diabetes Care.

"Our study revealed that a history of foot ulcer is a significant marker of higher risk of death not only for people in hospital settings but also in community health care," lead researcher Marjolein M. Iversen, of Bergen University College in Norway, told Reuters Health in an email.

That, she explained, underscores the importance of routine doctor visits -- both to monitor a diabetic patient's overall health, including heart disease risk factors and mental well-being, and for patients to learn how to prevent foot ulcers in the first place.

The findings are based on 65,126 adults taking part in a long-term health study; 1,339 had diabetes and no history of foot ulcers, while 155 had a history of the complication.

Over 10 years, half of those who'd suffered foot ulcers died, compared with 35 percent of diabetics without the complication and 10.5 percent of non-diabetic adults.

When the researchers factored in age, overall health, depression, education and lifestyle habits, the higher death risk in the foot-ulcer group persisted.

In general, experts recommend that people with diabetes take a number of measures to prevent foot ulcers -- with good blood sugar control being key to cutting the risk, as well as the risk of other diabetes complications.

Other recommendations include getting a complete foot exam at least once per year; regularly doing a self-check to spot any cuts, blisters or other abnormalities in the skin or toenails; and wearing socks and shoes at all times to cut the risk of foot injuries.

SOURCE: Diabetes Care, December 2009.