New ulceration, new major amputation, and survival rates in diabetic subjects hospitalized for foot ulceration from 1990 to 1993 - A 6.5-year follow-up

OBJECTIVE - To evaluate 1) the new ulceration, the new major amputation, an d the survival rates of 115 diabetic subjects hospitalized for foot ulcerat ion from 1990 to 1993, with an average follow-up of 6.5 years, and 2) the d emographic and clinical characteristics associated with these events. RESEARCH DESIGN AND METHODS - A total of 115 subjects, 31 women and 84 men, were monitored until 31 December 1998. All subjects were provided with the rapeutic shoes and received intense education. Data concerning new ulcerati on, new major amputation, and reamputation events and the date and cause of death were recorded for each patient. The prognostic factors for these eve nts were then evaluated. RESULTS - The average follow-up was 78.3 +/- 15.3 months (range 60-106). Du ring this time, 13 homolateral and 12 contralateral episodes of new ulcerat ion occurred. At univariate analysis none of the variables considered were significantly associated with the new ulceration. There were three major am putations: two of the limb previously healed and one of the contralateral l imb. Of the 115 subjects, 51 (44.3%) died: 24 of the 31 women (77.4%) and 2 7 of the 84 men (32.1%). Ischemic cardiopathy was the most frequent cause o f death (60.8%). Mortality concerned 20 of the 27 subjects (74.1%) undergoi ng major amputation from 1990 to 1993 and 31 of the 88 healed subjects (35. 2%), with a significant difference (P < 0.0001). Multivariate analysis show ed the independent role of the ankle-brachial index <less than or equal to> 0.5 (P = 0.005), age (P = 0.003), and female sex (P = 0.027). CONCLUSIONS - We believe that the use of therapeutic shoes and intense educ ational training, including the education of the family, have contributed t o the law incidence of new ulceration and major amputation in our study pop ulation. The high frequency of ischemic cardiopathy as a cause of death sho uld, perhaps, lead to a more aggressive diagnostic and therapeutic attitude toward this pathology in diabetic subjects admitted to hospitals for foot ulceration.