When DFU is One of Many Dimensions: Thoughts on New Research

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A recent cohort study published in Diabetologia by Holman and colleagues highlights the alarming short-term mortality rates in individuals presenting with new diabetes-related foot ulcers (DFUs).¹ The study analyzed data from 71,000 people registered in the National Diabetes Foot Care Audit (NDFA) in England and Wales, revealing mortality rates at 12, 26, and 52 weeks to be 4.2%, 8.2%, and 14.4%, respectively. These rates were notably higher among older individuals, those with larger or deeper ulcers, and those with cardiovascular or renal comorbidities.

Key findings of the study include:¹

• Older Age: Individuals aged 80 years and older had a 26-week mortality rate of 17.0%.
• Ulcer Characteristics: Larger ulcer area (≥1 cm^²), deep ulcers, and hindfoot location were associated with higher mortality.
• Comorbidities: Conditions such as heart failure, myocardial infarction, stroke, and chronic kidney disease (CKD) stage 3 or greater significantly increased mortality risk.

The authors emphasize that the high mortality rates observed, particularly in those with advanced age and multiple comorbidities, suggest the need for a shift in management priorities. Rather than focusing solely on ulcer healing, healthcare teams should consider integrating cardiovascular risk reduction, renal care coordination, and, in certain cases, palliative care strategies aimed at maximizing the quality of life.¹

Key Insights for Clinicians on DFU and Mortality

This study powerfully underscores that diabetic foot ulcer (DFU) care goes beyond wound healing alone, highlighting the high mortality rates associated with DFUs. These findings remind clinicians that we must view DFU management holistically, with an eye on the patient’s overall health trajectory. Mortality rates linked to DFU serve as a stark reminder of the systemic health issues at play and the critical need for early intervention.

Primary Factors DPMs Should Consider

Clinicians can benefit from integrating quality of life metrics into their DFU care protocols. This might mean adopting a broader set of goals beyond wound closure—such as pain reduction, enhanced mobility, and infection prevention—to give a fuller picture of the patient’s recovery. By focusing on these alternative metrics, clinicians can tailor care plans that align more closely with patients’ personal health goals, potentially improving both outcomes and patient satisfaction.

Dr. Armstrong is Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA).

This blog was adapted with permission from Dr. Armstrong and originally appeared here.

Reference
1.        Holman N, Yelland AC, Young B, et al. Mortality rates in people presenting with a new diabetes-related foot ulcer: a cohort study with implications for management. Diabetologia. 2024. https://doi.org/10.1007/s00125-024-06262-w.