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Long Term Outcome and Disability of Diabetic Patients Hospitalised for Diabetic Foot Ulcers: A 6.5 Year Follow-up Study

¹CHU Montpellier, Montpellier, F-34000 France
²Université Montpellier1, UFR de Médecine, EA 4202, Montpellier, F-34000 France

a-avignon{at}chu-montpellier.fr

ABSTRACT

Objective: The long-term outcome and functional status of subjects hospitalised for diabetic foot ulcers have been poorly studied and thus are the topics of this study.

Research design and methods: Ninety-four consecutive diabetic subjects hospitalized for diabetic foot ulcers between January 1998 and December 2000 were prospectively followed for 79.5±13.3 months. We calculated rates of primary healing, new ulcers, amputations, mortality, and disability and evaluated the global therapeutic success (GTS) of foot care management as defined by the association of primary healing without recurrence or disability at the end of follow-up.

Results: Follow-up was successful in 89/94 subjects (63 men/31 women, mean age 63.7±10.8 years). Of these, 69 (77.5%) experienced primary healing without major amputation, 39 (43.8%) underwent amputation (24 minor/15 major) and 46 died (51.7%), including 23 from cardiovascular events. Forty-two out of 69 patients who experienced primary healing (60.9%) had ulcer recurrence. At the end of the follow-up period, 25 patients (28.1%) were dependent and 40 subjects (44.9%) had achieved GTS. Multivariate analysis showed the independent role of age as a predictor of GTS (p<0.05) and of impaired renal function/albuminuria as independent predictors of healing failure, 1^st amputation and mortality (p<0.01).

Conclusions: Despite a satisfactory initial healing rate, the global long-term outcome of patients hospitalised for diabetic foot ulcers was poor. Nephropathy appears to be an important predictor of long-term outcome. Further studies are needed to establish recognised criteria for therapeutic success going beyond just the evaluation of healing rate in the management of diabetic foot ulcers.

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