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Diabetic Foot Ulcers Linked to Heart Attack, Stroke, and Premature Death

Researchers call for improved detection and management (Oct. 10)

People with diabetes who develop foot ulcers are at more risk of dying prematurely than are those without the complication, according to a study announced on October 10 by St. George’s, University of London, in the U.K. The researchers say the findings highlight the need for improved detection and management of patients with diabetes and foot ulcers.

The study was published in the current issue of Diabetologia.

Diabetes can damage a person’s blood vessels and nerves, especially if the person’s blood sugar is poorly controlled. Poor circulation and nerve damage in the feet make people vulnerable to unnoticed cuts or other injuries and progress into poorly healing ulcers. In severe cases, this can lead to foot or leg amputation.

In a study of 17,830 patients with diabetes — 3,095 with foot ulceration and 14,735 without — researchers investigated how diabetic foot ulcers affect a person’s risk of dying earlier. They found that those with a history of foot ulceration had a higher death rate than did those without. Each year, there were an extra 58 deaths per 1,000 people with diabetic foot ulcers.

The investigators analyzed patient records from eight studies conducted in the U.S., Europe, Australasia, and South-East Asia and published between 2006 and 2011. The length of time the health of the participants was followed varied between an average of 2 and 10 years for each of the studies.

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

The researchers say that the results underscore the importance of a two-pronged approach for people with diabetes: 1) enhanced foot-ulceration screening, as early detection and treatment may help reduce some of the complications, and 2) more intensive control of blood pressure and cholesterol among those diagnosed with foot ulcers, as these patients are at higher cardiovascular risk.

For more information, visit the St. George’s, University of London Web site.

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