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Mortality in Asian Indians with Charcot's neuroarthropathy: a nested cohort prospective study
Shakun Chaudhary1, Anil Bhansali1, Ashu Rastogi2
1Department of Endocrinology, PGIMER, Chandigarh, 160012, India.
Insights
Individuals with diabetes and Charcot neuroarthropathy (CN) face a nearly threefold increased mortality risk. This heightened risk persists even though they are diagnosed at a younger age, highlighting the severity of CN in diabetes management.
Area of Science:
- Diabetology
- Vascular Medicine
- Neurology
Background:
- Charcot neuroarthropathy (CN) is a severe complication of diabetic neuropathy.
- It significantly impacts foot health and mobility in individuals with diabetes.
- Understanding the long-term outcomes, particularly mortality, associated with CN is crucial for patient care.
Purpose of the Study:
- To investigate and compare mortality rates in diabetic patients with and without Charcot neuroarthropathy.
- To identify risk factors associated with increased mortality in the presence of CN.
- To assess the impact of CN on overall survival in the diabetic population.
Main Methods:
- A prospective study comparing two cohorts of diabetic patients: one with CN (Cohort 1) and one without foot complications (Cohort 2).
- Data collected included diabetes duration, microvascular/macrovascular complications, foot ulcers, amputations, and mortality.
- Multivariate logistic regression was used to compare outcomes between the cohorts.
Main Results:
- The study analyzed 260 diabetic individuals with CN and 520 without.
- Individuals with CN were younger at presentation and had a higher prevalence of microvascular complications.
- Mortality was 15% in the CN group versus 9.8% in the control group (p=0.03).
- CN was associated with a 2.7 times increased mortality risk (OR 2.72, p=0.003), with CAD and low eGFR being predictors of higher mortality.
Conclusions:
- Diabetic patients with Charcot neuroarthropathy exhibit a significantly higher risk of mortality.
- This increased mortality risk is evident despite patients being younger at the time of CN diagnosis.
- Early identification and management of complications like CAD and renal dysfunction are vital in CN patients.
Aims:
We studied mortality in individuals of diabetes with or without Charcot neuroarthropathy (CN).
Methods:
People attending diabetic foot care facility with CN of foot (Cohort 1) were prospectively evaluated. Details pertaining to the duration of diabetes, microvascular and macrovascular complications, foot ulcer, amputation and mortality outcomes were recorded and compared with those without foot complications (Cohort 2) by multivariate logistic regression.
Results:
Data for 260 individuals of diabetes with CN and 520 individuals without CN were analysed. Mean age at presentation with CN was 55.8 ± 9.1 years, and duration of diabetes was 12.9 ± 7.8 years. 39.8% individuals with CN had foot ulcer, and 15.3% had amputation. People with CN were younger (55 ± 9.1 vs. 59.9 ± 8.1 years, p < 0.001) and had higher prevalence of microvascular complications. A total of 39 (15%) individuals with CN and 50 (9.8%) (p = 0.03) individuals without CN died during median follow-up of 40(24-51) months. People with CN had 2.7 times (OR 2.72, 95% CI 1.4-5.2, p = 0.003) increased mortality risk when matched for potential confounders. Prevalent CAD and low eGFR predicted higher mortality in people with CN.
Conclusions:
People with Charcot neuroarthropathy have almost three times increased risk of mortality despite being younger at presentation.