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).
