A History of Foot ulcer increases Mortality among Persons with Diabetes. 10-year Follow-up of the Nord-Trøndelag Health Study, Norway

Abstract Objective — To compare mortality rates for persons with diabetes with and without a history of foot ulcer (HFU) and with the non-diabetic population. Research design and methods— This population-based study included 155 diabetic persons with a HFU, 1,339 diabetic persons without a HFU, and 63,632 non-diabetic persons who were all followed for 10 years with mortality as the end point. Results — During the follow-up period, a total of 49.0% of diabetic persons with a HFU died, compared to 35.2% of diabetic persons without a HFU and 10.5% of those without diabetes. In Cox regression analyses adjusted for age, sex, education, current smoking, and waist circumference, having a HFU was associated with more than a twofold (2.29 [95% CI 1.82–2.88]) hazard risk for mortality compared to the non-diabetic group. In corresponding analyses comparing diabetic persons with and without a HFU, a HFU was associated with 47% increased mortality (1.47 [1.14–1.89]). Significant covariates were older age, being male and current smoking. After also including HbA1c, insulin use, microalbuminuria, cardiovascular disease and depression scores in the model, each was significantly related to life expectancy. Conclusions — A HFU increased mortality risk among community-dwelling adults and elderly people with diabetes. The excess risk persisted after adjusting for comorbidity and depression scores, indicating that close clinical monitoring might be warranted among persons with a HFU, who may be particularly vulnerable to adverse outcomes.