Foot Ulcer and Risk of Lower Limb Amputation or Death in People With Diabetes: A National Population-Based Retrospective Cohort Study

Objective To describe incidence of foot ulceration and amputation free survival associated with foot ulceration status in a national population-based cohort study of people with diabetes. Research Design and Methods The study population included 233,459 people with diabetes who were alive in Scotland on 1st January 2012 identified from the national population-based register (national prevalence 4.9%). Characteristics of patients identified from linked hospital and mortality records during follow-up to the end of November 2017 were compared by outcome. Cox regression was used to assess the association between history of foot ulcer and amputation free survival. Results The population included 23,395 people with type-1 diabetes and 210,064 people with type-2 diabetes. In total there were 13,093 (5.6%) people with a previous foot ulceration, 9,023 people developed a first ulcer, 48,995 died and 2,866 underwent minor or major amputation during follow-up. Overall incidence of first time foot ulcers was 7.8 per 1000 person years (95% CI: 7.6-7.9) and 11.2 (11.0-11.4) for any ulcer. Risk factors for reduced amputation-free survival included social deprivation, mental illness and being underweight in addition to conventional cardiovascular risk factors. Adjusted hazards ratios (95% CI) were 2.09 (1.89-2.31) for type-1 diabetes and 1.65 (1.60-1.70) for type-2 diabetes. Conclusion The overall incidence of foot ulceration in a population-based study of people with diabetes was 11.2 per 1000 person years. Foot ulceration is associated with lower amputation-free survival, a potential measure of effectiveness of care among people with diabetes. Mental illness and social deprivation are also highlighted as risk factors.

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Cohort profile: the Funen Diabetes Database—a population-based cohort of patients with diabetes in Denmark

BMJ Open ◽

10.1136/bmjopen-2019-035492 ◽

2020 ◽

Vol 10 (4) ◽

pp. e035492

Author(s):

Kasper Adelborg ◽

Péter Szentkúti ◽

Jan Erik Henriksen ◽

Reimar Wernich Thomsen ◽

Lars Pedersen ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Geographical Area ◽

Population Based ◽

Haemoglobin A1c ◽

Patients With Diabetes

PurposeDetailed population-based data are essential to understanding the epidemiology of diabetes and its clinical course. This article describes the Funen Diabetes Database (FDDB). The purpose of the FDDB was to serve as a shared electronic medical record system for healthcare professionals treating patients with diabetes. The cohort can also be used for research.ParticipantsThe FDDB covers a geographical area of almost 500 000 Danish inhabitants. It currently includes 3691 patients with type 1 diabetes, 19 085 patients with type 2 diabetes, 292 patients with other types of diabetes and 5992 patients with an unknown type of diabetes. Patients have been continuously enrolled from general practitioners and endocrinology departments in the Funen area in Denmark since 2003. Patients undergo a clinical work-up at their first diabetes contact and during follow-up visits. The information collected includes type of diabetes contact, blood pressure, height, weight, lifestyle factors (smoking, exercise), laboratory records (eg, haemoglobin A1c and cholesterol levels), results from foot examinations (eg, pulse, cutaneous sensitivity and ankle brachial index), results from eye examinations (eg, degree of retinopathy assessed by retinal photo and eye examination), glucose-lowering drugs and diabetic complications.Findings to dateThe FDDB cohort was followed for a total of 212 234 person-years up to 2016. A cross-sectional study described the prevalence of diabetic retinopathy and its associated risk factors. The clinical outcomes of patients with type 1 diabetes, type 2 diabetes and latent autoimmune diabetes in adults have been assessed. Linkage to population-based medical registries with complete follow-up has enabled the collection of extensive continuous data on general practice contacts, diagnoses and procedures from hospital contacts, medication use and mortality.Future plansThe FDDB serves as a strong data resource that will be used in future studies of diabetes epidemiology with focus on occurrence, risk factors, treatment, complications and prognosis.

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Abstract 555: The Universal Clinical Classification of Acute Myocardial Infarction is a Better Predictor of Long Term Outcomes than ST Segment Classification

Circulation ◽

10.1161/circ.118.suppl_18.s_579-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Manuel A Gonzalez ◽

Dana Eilen ◽

Rana A Marzouq ◽

Saed Awadallah ◽

Hiren R Patel ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Inverse Relationship ◽

Long Term Outcomes ◽

St Segment ◽

Vascular Beds

Introduction: The universal classification (UC) of AMI aims to facilitate cross-study analysis, yet the long-term outcomes using UC are largely unknown. Hypothesis: We tested the hypothesis that the long-term outcome of patients with AMI is better predicted by UC than ST segment classification. Methods: We conducted a prospective study of 348 consecutive patients with AMI with mean follow-up of 30.6 months. The primary outcome was the major adverse cardiovascular events (MACE) [composite of all causes of mortality, recurrent AMI, and stroke]. Multivariate and survival analysis of MACE was performed. Results: The study population was STEMI=168, NSTEMI=180, Type 1=278, Type 2=55, Type 3=5, Type 4a=2, Type 4b=5, and Type 5=3. During follow-up 80 patients died, 31 had an AMI, and 7 had a stroke. UC correlates with the ST segment classification (p<0.005). MACE free survival was different for Type 1 and Type 2 (p=0.043), but not for STEMI and NSTEMI. There was a positive association between MACE and the quartile of peak Troponin, number of cardiovascular risk factors, and number of vascular beds affected, and an inverse relationship with the utilization of discharge cardiovascular protective medications (all p≤0.01). No such inverse relationship existed for Type 2. Conclusions: UC of AMI is a better long-term predictor of MACE. The quartile of peak Troponin levels, cardiovascular risk factors, and number of vascular beds affected are independent predictors of MACE, while cardiac medications protect against MACE, except in Type 2 patients.

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