Hsu Chun-Chien, Lai Hsi-Yu, Lin Hung-Yu, Pan Sung-Ching, Cheng Nai-Chen, Chen Liang-Kung, Hsiao Fei-Yuan, Lin Shu-Wen
Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Health Data Research Center, National Taiwan University, Taipei, Taiwan.
Open Forum Infect Dis. 2024 May 8;11(6):ofae276. doi: 10.1093/ofid/ofae276. eCollection 2024 Jun.
Foot complications are common in people with diabetes mellitus (DM), leading to increased health care utilization, heightened mortality risk, and notable recurrence rates even after treatment. This retrospective cohort study aimed to investigate the impact of repeated occurrence of DM-related foot complications on the risk of all-cause mortality and to identify the potential risk factors associated with repeated events.
People with DM admitted with foot complications (ulcer, skin and soft tissue infection, or osteomyelitis) from 2012 to 2014 were identified from Taiwan's National Health Insurance Research Database, with a 3-year follow-up for repeated events. We categorized the study subjects based on their cumulative number of hospital admissions with foot complications. Logistic regression was conducted to explore the potential risk factors associated with repeated diabetic foot events. Kaplan-Meier curves and Cox proportional hazard models were used to examine the associations between repeated diabetic foot events and all-cause mortality.
In this study, 28 754 eligible individuals were enrolled and classified into 3 groups: no repeated diabetic foot events (76.1%), 1 repeated event (16.0%), and 2 or more repeated events (7.9%). Logistic regression revealed that advanced age, male sex, congestive heart failure, dyslipidemia, hypertension, nephropathy, retinopathy, neuropathy, peripheral vascular disease, diabetes-related preventable hospitalizations, and outpatient visits due to diabetic foot were significantly associated with repeated events of diabetic foot complications. Compared with those with no repeated events, the adjusted hazard ratios for all-cause mortality were 1.26 (95% CI, 1.19-1.34) for 1 repeated event and 1.36 (95% CI, 1.26-1.47) for 2 or more repeated events.
The significant association between repeated diabetic foot and elevated mortality risk highlights the critical necessity for proactive and targeted patient care within clinical practice. More research to delve into the predictive factors related to the repeated occurrence of diabetic foot is needed to provide additional insights for prevention strategies.
足部并发症在糖尿病患者中很常见，会导致医疗保健利用率增加、死亡风险升高，甚至在治疗后复发率也很高。这项回顾性队列研究旨在调查糖尿病相关足部并发症的反复发生对全因死亡率风险的影响，并确定与反复发生事件相关的潜在风险因素。
从台湾国民健康保险研究数据库中识别出2012年至2014年因足部并发症（溃疡、皮肤和软组织感染或骨髓炎）入院的糖尿病患者，并对反复发生的事件进行3年随访。我们根据足部并发症的累计住院次数对研究对象进行分类。进行逻辑回归以探索与糖尿病足反复事件相关的潜在风险因素。采用Kaplan-Meier曲线和Cox比例风险模型来检验糖尿病足反复事件与全因死亡率之间的关联。
在本研究中，共纳入28754名符合条件的个体，并分为3组：无糖尿病足反复事件组（76.1%）、1次反复事件组（16.0%）和2次或更多次反复事件组（7.9%）。逻辑回归显示，高龄、男性、充血性心力衰竭、血脂异常、高血压、肾病、视网膜病变、神经病变、外周血管疾病、糖尿病相关可预防住院以及因糖尿病足进行的门诊就诊与糖尿病足并发症的反复事件显著相关。与无反复事件者相比，1次反复事件的全因死亡率调整后风险比为1.26（95%CI，1.19-1.34），2次或更多次反复事件的为1.36（95%CI，1.26-1.47）。
糖尿病足反复发生与死亡率风险升高之间的显著关联凸显了临床实践中积极主动和有针对性的患者护理的迫切必要性。需要更多研究深入探讨与糖尿病足反复发生相关的预测因素，以便为预防策略提供更多见解。
