Diabetic foot ulcers, their characteristics, and trends in survival: Real world outcomes at a tertiary care facility in India

Abstract

Aims

Characteristics of diabetes-related foot ulcers (DFU), association with recurrence and amputation are poorly described in the Asian Indian population.

Methods

A prospectively maintained database was reviewed to characterize DFU and its association with amputation and recurrence.

Results

Of 200 patients, 63.5 % were male, the median age was 62 years (Min-Max:40–86), and median BMI was 27.90 kg/m² (Min-Max:18.5–42.7). Median duration of Diabetes mellitus was 15 years (Min-Max:2–43). Complete healing occurred at a median of three months (Min-Max:0.23–37.62). Amputation for the current ulcer was required in 43.4 % of individuals. Ulcer recurrence was documented in 42.4 % instances, 66.1 % evolving on the ipsilateral side. Previous amputation was associated with the risk of subsequent amputation (Adjusted OR-3.08,p-0.047). Median time to ulcer recurrence was 4.23 years among those with amputation, in contrast to 9.61 years in those with healing. Cardiovascular death was the commonest cause of mortality, followed by sepsis. At a median follow up of 6.08 years, mortality at 1,3,5 and 10 years was 2.5 %,2.5 %,8.2 % and 30.9 % respectively among those who underwent amputation versus 0 %,0 %,10.1 % and 24.5 % respectively for those who achieved healing.

Conclusions

Patients with DFU in India incur amputations at rates higher than conventionally described. With previous amputation, subsequent amputation risk triples. Ten-year mortality is 25%–30 %. Underestimates of the burden of recurrence and mortality are consequential of limited follow-up.