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McEwen LN, Ylitalo KR, Munson M, Herman WH, Wrobel JS, et al.
Journal of the American Podiatric Medical Association. Date of publication 2016 Jan 1;volume 106(1):7-14.
1. J Am Podiatr Med Assoc. 2016 Jan-Feb;106(1):7-14. doi: 10.7547/14-115. Foot Complications and Mortality: Results from Translating Research Into Action for Diabetes (TRIAD). McEwen LN, Ylitalo KR, Munson M, Herman WH, Wrobel JS. BACKGROUND: We sought to study the impact of foot complications on 10-year mortality independent of other demographic and biological risk factors in a racially and socioeconomically diverse managed-care population with access to high-quality medical care. METHODS: We studied 6,992 patients with diabetes in Translating Research Into Action for Diabetes (TRIAD), a prospective observational study of diabetes care in managed care. Foot complications were assessed using administrative claims data. The National Death Index was searched for deaths across 10 years of follow-up (2000-2009). RESULTS: Charcot's neuro-osteoarthropathy and diabetic foot ulcer with debridement were associated with an increased risk of mortality; however, the associations were not significant in fully adjusted models. Lower-extremity amputation (LEA) was associated with an increased risk of mortality in unadjusted (hazard ratio [HR], 3.21; 95% confidence interval [CI], 2.50-4.12) and fully adjusted (HR, 1.84; 95% CI, 1.28-2.63) models. When we examined the associations between LEA and mortality stratified by sex and race, risk was increased in men (HR, 1.96; 95% CI, 1.25-3.07), Hispanic individuals (HR, 5.17; 95% CI, 1.48-18.01), and white individuals (HR, 2.18; 95% CI, 1.37-3.47). In sensitivity analyses, minor LEA tended to increase the risk of mortality (HR, 1.48; 95% CI, 0.92-2.40), and major LEA was associated with a significantly higher risk of death at 10 years (HR, 1.89; 95% CI, 1.18-3.01). CONCLUSIONS: In this managed-care population with access to high-quality medical care, LEA remained a robust independent predictor of mortality. The association was strongest in men and differed by race. DOI: 10.7547/14-115 PMCID: PMC5094452 PMID: 26895355 [Indexed for MEDLINE] Conflict of interest statement: No potential conflicts of interest relevant to this article were reported. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the funding agency(s).
Appears in following Topics:
Diabetic Foot Ulcer - Introduction and Assessment
Diabetic Foot Ulcer - Treatment