Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036, Graz, Austria.
Joanneum Research Forschungsgesellschaft m.b.H, HEALTH - Institute for Biomedicine and Health Sciences, Neue Stiftingtalstrasse 2, A-8010, Graz, Austria.
Sci Rep. 2019 Jul 17;9(1):10325. doi: 10.1038/s41598-019-46961-8.
Patients with previous diabetic foot ulcer are prone to re-ulceration and (re)amputation, to various comorbidities, have significantly impaired quality of life and increased mortality. We aimed to evaluate the risk of foot related complications and mortality in a high-risk population of patients with healed diabetic foot syndrome over a decade. 91 patients with recently healed diabetic foot ulcer were invited for follow-up at 1, 6 and 11 years after inclusion. Patient characteristics at inclusion were: 40 women, 65 ± 11 years, diabetes type 1 (n = 6) or 2 (n = 85), BMI 28.5 ± 4.4 kg/m, and HbA1c 68 ± 17 mmol/mol. Comorbidities included neuropathy (n = 91), peripheral artery disease (PAD), history of minor (n = 25) or major (n = 5, 5.5%) amputation, nephropathy (n = 40) and retinopathy (n = 53). Ulceration recurred in 71 (65%) patients, time to first recurrence was 1.8 ± 2.4 years (mean ± SD). 21 patients had to undergo (re)amputation (minor n = 19, major n = 2), time to amputation was 3.6 ± 1.9 years. Over time, 3 further major amputations were required in patients with an initial minor amputation. Thirty-three (36%) of the initially included patients completed the follow-up period of 11.0 ± 0.6 years. 58 patients (64%) died during the observational period, time to death was 5 ± 3 years in this group. We found overall high mortality of 64% throughout the follow-up period of 11 years in high-risk patients with healed diabetic foot syndrome. Presence of PAD, prior amputation and nephropathy as well as poor glycemic control were significantly predictive for death.
患有既往糖尿病足溃疡的患者容易再次发生溃疡和（再次）截肢，易发生各种合并症，生活质量显著受损，死亡率增加。我们旨在评估在过去十年中，愈合的糖尿病足综合征高危人群中与足部相关并发症和死亡率的风险。在纳入后 1、6 和 11 年，邀请 91 名新近愈合的糖尿病足溃疡患者进行随访。纳入时患者的特征为：女性 40 名，年龄 65±11 岁，1 型糖尿病（n=6）或 2 型（n=85），BMI 28.5±4.4kg/m，和 HbA1c 68±17mmol/mol。合并症包括神经病（n=91）、外周动脉疾病（PAD）、既往小（n=25）或大（n=5，5.5%）截肢史、肾病（n=40）和视网膜病变（n=53）。71 名（65%）患者溃疡复发，首次复发时间为 1.8±2.4 年（平均值±标准差）。21 名患者需要（再次）截肢（小截肢 n=19，大截肢 n=2），截肢时间为 3.6±1.9 年。在初始小截肢患者中，随着时间的推移，又有 3 例需要大截肢。33 名（36%）最初纳入的患者完成了 11.0±0.6 年的随访期。58 名患者（64%）在观察期间死亡，该组的死亡时间为 5±3 年。我们发现，在过去 11 年的随访期间，患有愈合的糖尿病足综合征的高危患者的总体死亡率为 64%。PAD 的存在、既往截肢和肾病以及血糖控制不佳是死亡的显著预测因素。
