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Mortality and complications after treatment of acute diabetic Charcot foot
Rasmus Bo Jansen1, Bo Jørgensen2, Per E Holstein2
1Department of Endocrinology, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen NV, Denmark.
Insights
Charcot foot in diabetic patients can lead to severe complications and workforce exit. Adherence to treatment significantly improves outcomes and reduces complication rates in this vulnerable population.
Area of Science:
- Diabetology
- Podiatry
- Vascular Surgery
Background:
- Charcot foot is a severe complication of diabetic neuropathy, potentially causing limb-threatening deformities.
- Early identification and management are crucial to prevent long-term disability.
Purpose of the Study:
- To investigate the outcomes and complications of Charcot foot in a diabetic population.
- To assess the impact of treatment compliance on patient prognosis.
Main Methods:
- Retrospective study of 173 patients diagnosed with Charcot foot between 1996 and 2015.
- Data collected from medical records and the Danish Diabetes Registry.
- Analysis of patient demographics, treatment adherence, complications, and mortality.
Main Results:
- Type 1 diabetes patients had higher HbA1c levels compared to type 2 diabetes patients.
- 67% of patients developed complications like ulcers; non-compliance was linked to worse outcomes.
- Five-year mortality was 14%, comparable to diabetic patients without Charcot foot.
Conclusions:
- Charcot foot is associated with significant complications and workforce exit.
- Patient compliance with treatment, particularly off-loading, is critical for managing Charcot foot.
- Mortality rates are comparable to the general diabetic population, highlighting the importance of proactive management.
Aims:
Charcot foot is a rare but disabling complication to diabetic neuropathy, and can cause permanent, limb-threatening deformities. The aim of this study was to investigate a population of patients a Charcot foot on a case-by-case basis, in order to assess the consequences of an acute Charcot foot and its complications.
Methods:
The study was conducted a retrospective study of patients admitted to the Copenhagen Wound Healing Center between 1996 and 2015 with the diagnosis of Charcot foot (DM14.6) and diabetes mellitus type 1 or 2 (DE10.X and DE11.X). Physical and electronic records were used, and compared to data from the Danish Diabetes Registry.
Results:
In total 392 patients were identified of which 173 were included. There were 26% with type 1 diabetes (initial HbA1c 81.7 ± 21.4 mmol/mol) and 74% with type 2 diabetes (initial HbA1c 66.5 ± 20.3 mmol/mol). Primary off-loading was with a removable walker in 95% of the cases (average off-loading time 8.3 months). The 5-year mortality was 14% with a mean survival time of 12.7 years. There was an association between lack of compliance and occurrence of foot complications, as well as between having a Charcot foot and leaving the workforce.
Conclusion:
More patients had type 1 diabetes compared to the background population, and they had a higher HbA1c than the general population of diabetes patients. A total of 67% developed complications such as ulcers, while patients non-compliant to treatment did significantly worse than those being compliant. The 5-year mortality was low, 14%, and comparable to diabetes patients without Charcot foot.
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