February 15, 2022
2 min read
Petersen is co-founder, chief scientist and shareholder of Podimetrics. Please see the study for all other authors’ relevant financial disclosures.
Diabetic foot ulcer episodes were associated with all-cause mortality and all-cause inpatient hospital admissions, according to new results published in Diabetes Research and Clinical Practice.
Brian J. Petersen
“The impact of diabetic foot ulcers has been historically difficult to quantify, but our study shows that these foot wounds are associated with higher rates of all-cause hospitalization and all-cause mortality,” Brian J. Petersen, co-founder and chief scientist at Podimetrics, told Healio. “In our research, we found that during episodes-of-care for diabetic foot ulcers, individuals are 50% more likely to die and nearly three times more likely to be hospitalized.”
Researchers evaluated data included in the Medicare Limited Data Set between 2013 and 2019 from 78,716 beneficiaries (mean age, 70.9 years) identified with at least one diabetic food ulcer episode. Episodes-of-care were defined by clustering diabetic foot ulcer-related claims with the longest time interval between consecutive claims that was not longer than a duration adjusted to match both a healing rate at 12 weeks and reulcertaion rate following healing. Researchers compared these data on outcome rates during ulceration periods with rates immediately after healing to assess incidence.
Researchers identified 206,203 diabetic foot ulcer episodes with an average of 2.6 episodes per beneficiary. The incidence rate was 4.6 diabetic foot ulcers per 100 beneficiary-years among those with diabetes. The minimum mean relative error was 4.2% using the two validation criteria and a clustering duration of 7 weeks in the episode-of-care model.
All-cause inpatient hospital admissions were almost three times more likely during foot ulcer episodes (incidence ratio = 2.8; 95% CI, 2.77-2.87) and mortality was 50% more likely compared with periods after healing (incidence ratio = 1.5; 95% CI, 1.44-1.54).
In addition, diabetic foot ulcer episodes were associated hospitalization for lower limb amputation for endocrine, nutritional and metabolic disorders with major complication or comorbidity (IR = 30; 95% CI, 24.5–38.1) and cellulitis with major complication or comorbidity (IR = 4.01; 95% CI, 3.5–4.6) as well as for heart failure and shock with complication or comorbidity (IR = 2.2; 95% CI, 1.8-2.2) and renal failure with complication or comorbidity (IR = 1.94; 95% CI, 1.7-2.1).
According to the researchers, these results suggest that better preventive care could influence outcomes for conditions not traditionally linked to diabetic foot ulcers.
“We recommend ongoing research to further establish the link between diabetic foot complications and other complex chronic conditions,” Petersen said. “Most urgently, this research shows the need for increased development and deployment of accessible solutions that focus on the prevention of diabetic foot complications through proactive care.”