Risk factors for development of diabetic foot ulcer disease in two large contemporary UK cohorts

Diabetic foot ulcer disease (DFUD) is common, life-changing and associated with a lower 5-Year survival rate than many cancers. However, the risk factors for DFUD have generally been identified in small, single-centre, clinic-based studies, many of which are cross-sectional. This study aims to assess the incidence of DFUD and its related risk factors in two large, contemporary UK cohorts.

We investigated common sociodemographic and clinical factors affecting the incidence rates of DFUD in two large representative independent cohorts of people with diabetes in England (CPRD, n = 131 042) and Scotland (Scottish Diabetes Research Network-National Diabetes Dataset [SDRN-NDS] n = 260 748). The methods of case ascertainment differed between the two cohorts: in England, both primary and secondary care data were used, whereas in Scotland, secondary care and foot clinic data were used.

In the English cohort, 4.7% developed DFUD over a median of 4.3years (incidence rate 9.0[95%CI: 8.8-9.2] per 1000 person-years) follow-up; in the Scottish cohort, the equivalent figure was 2.9% over a median of 6.3 years (incidence rate 4.4 [95% CI: 4.3-4.5] per 1000 person-years). Despite different methods of case ascertainment, multivariable analysis in both populations indicated that those who developed DFUD were more likely to be older, male, smokers, of White ethnicity, with higher systolic blood pressure and baseline HbA1c. These findings provide a robust evidence base for identifying people with diabetes at risk of DFUD for targeted efforts for prevention.