Six-month Outcomes of Patients Admitted for Diabetic Foot Attack

Abstract

The study aimed to evaluate the mid-term outcomes of patients admitted for a diabetic foot attack (DFA). It is a retrospective observational study including a population of patients admitted for diabetic foot ulcers (DFUs) into a specialized multidisciplinary diabetic foot service. Based on the type of hospital admission (emergency or elective), patients were divided into two groups: those with DFA and those without DFA (chronic diabetic foot, CDF). The DFA was considered in case of ischemia (acute or chronic), infection and Charcot foot requiring urgent hospitalization. Once discharged, patients were regularly followed as outpatients with the following six-month outcomes: healing; major amputation; mortality; hospital readmission; non-fatal major adverse limb and cardiovascular events (MALCE) including nonfatal myocardial infarction (MI), nonfatal stroke, and limb ischemia requiring revascularization. Overall, 141 patients were included. The mean age was 70 ± 12 years, most patients were male (76.6%) and had type 2 diabetes (93.6%) with a mean duration of 22 ± 13 years; 81 (57.4%) patients presented DFA while 60 (42.6%) presented CDF. No cases of admitted Charcot foot were recorded. The DFA group reported 81.5% cases of severe/moderate infections, while the CDF group presented 50% of mild infections. The DFA group reported higher HbA1c values (67 ± 22 vs 56 ± 14 mmol/mol, p = 0.0008) and more cases of first assessment for DFUs (59.3 vs 13.3%, p < 0.0001) when compared to the CDF group. The six-month follow-up outcomes for DFA and CDF were: healing (65.4 vs 60.0%, p = 0.3); major amputation (4.9 vs 1.7%, p = 0.2); mortality (8.6 vs 11.7%, p = 0.5); hospital readmission (27.2 vs 26.7%, p = 0.8); non-fatal MALCE (9.9 vs 23.3%, p = 0.1). Six-month outcomes did not show significant differences between the DFA and CDF groups in terms of healing, major amputation, mortality, readmission, and non-fatal MALCE. Adequate management of DFA seems to ensure favourable mid-term outcomes, even if compared to patients with CDF.