Skip to main content
Erschienen in: Diabetologia 11/2012

01.11.2012 | Meta-analysis

The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis

verfasst von: J. R. W. Brownrigg, J. Davey, P. J. Holt, W. A. Davis, M. M. Thompson, K. K. Ray, R. J. Hinchliffe

Erschienen in: Diabetologia | Ausgabe 11/2012

Einloggen, um Zugang zu erhalten

Abstract

Aims/hypothesis

It is well established that diabetes mellitus increases the risk of cardiovascular disease (CVD) and all-cause mortality. Observational studies suggest that a history of diabetic foot ulceration (DFU) may increase this risk further still. We sought to determine to what extent DFU is associated with excess risk over and above diabetes.

Methods

We identified studies reporting on associations of DFU with CVD and all-cause mortality. We obtained data on incident events of all-cause mortality, fatal myocardial infarction and fatal stroke. Study-specific estimates were pooled using a random-effects meta-analysis and the statistical heterogeneity of included studies was assessed using the I 2 statistic.

Results

The eight studies included reported on 3,619 events of all-cause mortality during 81,116 person-years of follow-up. DFU was associated with an increased risk of all-cause mortality (RR 1.89, 95% CI 1.60, 2.23), fatal myocardial infarction (2.22, 95% CI 1.09, 4.53) and fatal stroke (1.41, 95% CI 0.61, 3.24). CVD mortality accounted for a similar proportion of deaths in DFU and non-DFU patients.

Conclusions/interpretation

Patients with DFU have an excess risk of all-cause mortality, compared with patients with diabetes without a history of DFU. This risk is attributable, in part, to a greater burden of CVD. If this result is validated in other studies, strategies should evaluate the role of further aggressive CVD risk modification and ulcer prevention in those with DFU.
Literatur
1.
Zurück zum Zitat Preis SR, Hwang SJ, Coady S et al (2009) Trends in all-cause and cardiovascular disease mortality among women and men with and without diabetes mellitus in the Framingham Heart Study, 1950 to 2005. Circulation 119:1728–1735PubMedCrossRef Preis SR, Hwang SJ, Coady S et al (2009) Trends in all-cause and cardiovascular disease mortality among women and men with and without diabetes mellitus in the Framingham Heart Study, 1950 to 2005. Circulation 119:1728–1735PubMedCrossRef
2.
Zurück zum Zitat Pham H, Armstrong DG, Harvey C, Harlkess LB, Giurni JM, Veves A (2000) Screening techniques to identify people at high risk for diabetic foot ulceration. Diabetes Care 23:606–611PubMedCrossRef Pham H, Armstrong DG, Harvey C, Harlkess LB, Giurni JM, Veves A (2000) Screening techniques to identify people at high risk for diabetic foot ulceration. Diabetes Care 23:606–611PubMedCrossRef
3.
Zurück zum Zitat Silbernagel G, Rosinger S, Grammer TB et al (2012) Duration of type 2 diabetes strongly predicts all-cause and cardiovascular mortality in people referred for coronary angiography. Atherosclerosis 221:551–557PubMedCrossRef Silbernagel G, Rosinger S, Grammer TB et al (2012) Duration of type 2 diabetes strongly predicts all-cause and cardiovascular mortality in people referred for coronary angiography. Atherosclerosis 221:551–557PubMedCrossRef
4.
Zurück zum Zitat Wannamethee SG, Shaper AG, Whincup PH, Lennon L, Sattar N (2011) Impact of diabetes on cardiovascular disease risk and all-cause mortality in older men: influence of age at onset, diabetes duration, and established and novel risk factors. Arch Intern Med 171:404–410PubMedCrossRef Wannamethee SG, Shaper AG, Whincup PH, Lennon L, Sattar N (2011) Impact of diabetes on cardiovascular disease risk and all-cause mortality in older men: influence of age at onset, diabetes duration, and established and novel risk factors. Arch Intern Med 171:404–410PubMedCrossRef
5.
Zurück zum Zitat DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188PubMedCrossRef DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188PubMedCrossRef
6.
Zurück zum Zitat Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101PubMedCrossRef Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101PubMedCrossRef
7.
Zurück zum Zitat Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634PubMedCrossRef Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634PubMedCrossRef
8.
Zurück zum Zitat Boyko EJ, Ahroni JH, Smith DG, Davignon D (1996) Increased mortality associated with diabetic foot ulcer. Diabet Med 13:967–972PubMedCrossRef Boyko EJ, Ahroni JH, Smith DG, Davignon D (1996) Increased mortality associated with diabetic foot ulcer. Diabet Med 13:967–972PubMedCrossRef
9.
Zurück zum Zitat Ramsey SD, Newton K, Blough D et al (1999) Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care 22:382–387PubMedCrossRef Ramsey SD, Newton K, Blough D et al (1999) Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care 22:382–387PubMedCrossRef
10.
Zurück zum Zitat Pham H, Armstrong DG, Harvey C, Harkless LB, Giurni JM, Veves A (2000) Screening techniques to identify people at high risk for diabetic foot ulceration. Diabetes Care 23:606–611PubMedCrossRef Pham H, Armstrong DG, Harvey C, Harkless LB, Giurni JM, Veves A (2000) Screening techniques to identify people at high risk for diabetic foot ulceration. Diabetes Care 23:606–611PubMedCrossRef
11.
Zurück zum Zitat Davis WA, Norman PE, Bruce DG, Davis TME (2006) Predictors, consequences and costs of diabetes-related lower extremity amputation complicating type 2 diabetes: The Fremantle Diabetes Study. Diabetologia 49:2634–2641PubMedCrossRef Davis WA, Norman PE, Bruce DG, Davis TME (2006) Predictors, consequences and costs of diabetes-related lower extremity amputation complicating type 2 diabetes: The Fremantle Diabetes Study. Diabetologia 49:2634–2641PubMedCrossRef
12.
Zurück zum Zitat Pinto A, Tuttolomondo A, Di Raimondo D et al (2008) Cardiovascular risk profile and morbidity in subjects affected by type 2 diabetes mellitus with and without diabetic foot. Metabolism 57:676–682PubMedCrossRef Pinto A, Tuttolomondo A, Di Raimondo D et al (2008) Cardiovascular risk profile and morbidity in subjects affected by type 2 diabetes mellitus with and without diabetic foot. Metabolism 57:676–682PubMedCrossRef
13.
Zurück zum Zitat Sohn MW, Todd AL, Stuck RM, Frykberg RG, Budima-Mak E (2009) Mortality of charcot arthropathy compared with that of diabetic foot ulcer and diabetes alone. Diabetes Care 32:816–821PubMedCrossRef Sohn MW, Todd AL, Stuck RM, Frykberg RG, Budima-Mak E (2009) Mortality of charcot arthropathy compared with that of diabetic foot ulcer and diabetes alone. Diabetes Care 32:816–821PubMedCrossRef
14.
Zurück zum Zitat Iversen MM, Tell GS, Riise T et al (2009) History of foot ulcer increases mortality among individuals with diabetes. Ten-year follow up of the Nord-Trondelag Health Study, Norway. Diabetes Care 32:2193–2199PubMedCrossRef Iversen MM, Tell GS, Riise T et al (2009) History of foot ulcer increases mortality among individuals with diabetes. Ten-year follow up of the Nord-Trondelag Health Study, Norway. Diabetes Care 32:2193–2199PubMedCrossRef
15.
Zurück zum Zitat Junrungsee S, Kosachunhanun N, Wongthanee A, Rerkasem K (2011) History of foot ulcers increases mortality among patients with diabetes in Northern Thailand. Diabet Med 28:608–611PubMedCrossRef Junrungsee S, Kosachunhanun N, Wongthanee A, Rerkasem K (2011) History of foot ulcers increases mortality among patients with diabetes in Northern Thailand. Diabet Med 28:608–611PubMedCrossRef
16.
Zurück zum Zitat Moulik PK, Mtonga R, Gill GV (2003) Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology. Diabetes Care 26:491–494PubMedCrossRef Moulik PK, Mtonga R, Gill GV (2003) Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology. Diabetes Care 26:491–494PubMedCrossRef
17.
Zurück zum Zitat UKPDS 33 (1998) Intensive blood glucose control with sulphonylurea or insulin compared with conventional treatment and the risk of complications in type 2 diabetes. Lancet 352:837–853CrossRef UKPDS 33 (1998) Intensive blood glucose control with sulphonylurea or insulin compared with conventional treatment and the risk of complications in type 2 diabetes. Lancet 352:837–853CrossRef
18.
Zurück zum Zitat Vinik AI, Ziegler D (2007) Diabetic cardiovascular autonomic neuropathy. Circulation 115:387–397PubMedCrossRef Vinik AI, Ziegler D (2007) Diabetic cardiovascular autonomic neuropathy. Circulation 115:387–397PubMedCrossRef
19.
Zurück zum Zitat Jeffcoate WJ, Rasmussen LM, Hofbauer LC, Game FL (2009) Medial arterial calcification in diabetes and its relationship to neuropathy. Diabetologia 52:2478–2488PubMedCrossRef Jeffcoate WJ, Rasmussen LM, Hofbauer LC, Game FL (2009) Medial arterial calcification in diabetes and its relationship to neuropathy. Diabetologia 52:2478–2488PubMedCrossRef
20.
Zurück zum Zitat Cusick M, Meleth AD, Agron E et al (2005) Associations of mortality and diabetes complications in patients with Type 1 and Type 2 diabetes. Early treatment diabetic retinopathy study report no 27. Diabetes Care 28:617–625PubMedCrossRef Cusick M, Meleth AD, Agron E et al (2005) Associations of mortality and diabetes complications in patients with Type 1 and Type 2 diabetes. Early treatment diabetic retinopathy study report no 27. Diabetes Care 28:617–625PubMedCrossRef
21.
Zurück zum Zitat Jeffcoate WJ (2011) Stratification of foot risk predicts the incidence of new foot disease, but do we yet know that the adoption of routine screening reduces it? Diabetologia 54:991–993PubMedCrossRef Jeffcoate WJ (2011) Stratification of foot risk predicts the incidence of new foot disease, but do we yet know that the adoption of routine screening reduces it? Diabetologia 54:991–993PubMedCrossRef
22.
Zurück zum Zitat Abbott CA, Carrington AL, Ashe H et al (2002) The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med 19:377–384PubMedCrossRef Abbott CA, Carrington AL, Ashe H et al (2002) The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med 19:377–384PubMedCrossRef
23.
Zurück zum Zitat Gaede P, Lund-Andersen H, Parving HH, Pedersen O (2008) Effect of multifactorial intervention on mortality in type 2 diabetics. N Engl J Med 358:580–591PubMedCrossRef Gaede P, Lund-Andersen H, Parving HH, Pedersen O (2008) Effect of multifactorial intervention on mortality in type 2 diabetics. N Engl J Med 358:580–591PubMedCrossRef
24.
Zurück zum Zitat Dinneen SF, Gerstein HC (1997) The association of microalbuminuria and mortality in non-insulin dependent diabetes mellitus. Arch Intern Med 157:1413–1418PubMedCrossRef Dinneen SF, Gerstein HC (1997) The association of microalbuminuria and mortality in non-insulin dependent diabetes mellitus. Arch Intern Med 157:1413–1418PubMedCrossRef
25.
Zurück zum Zitat Agewall S, Wikstrand J, Ljungman S, Fagerberg B, for the Risk Factor Intervention Study Group (1997) Usefulness of microalbuminuria in predicting cardiovascular mortality in treated hypertensive men with and without diabetes mellitus. Am J Cardiol 80:164–169PubMedCrossRef Agewall S, Wikstrand J, Ljungman S, Fagerberg B, for the Risk Factor Intervention Study Group (1997) Usefulness of microalbuminuria in predicting cardiovascular mortality in treated hypertensive men with and without diabetes mellitus. Am J Cardiol 80:164–169PubMedCrossRef
26.
Zurück zum Zitat Young MJ, McCardle JE, Randall LE, Barclay JI (2008) Improved survival of diabetic foot ulcer patients 1995-2008: possible impact of aggressive cardiovascular risk management. Diabetes Care 31:2143–2147PubMedCrossRef Young MJ, McCardle JE, Randall LE, Barclay JI (2008) Improved survival of diabetic foot ulcer patients 1995-2008: possible impact of aggressive cardiovascular risk management. Diabetes Care 31:2143–2147PubMedCrossRef
Metadaten
Titel
The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis
verfasst von
J. R. W. Brownrigg
J. Davey
P. J. Holt
W. A. Davis
M. M. Thompson
K. K. Ray
R. J. Hinchliffe
Publikationsdatum
01.11.2012
Verlag
Springer-Verlag
Erschienen in
Diabetologia / Ausgabe 11/2012
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-012-2673-3

Weitere Artikel der Ausgabe 11/2012

Diabetologia 11/2012 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.