Association between frailty progression and clinical outcomes in patients with diabetic foot ulcers

Frailty is a critical determinant of adverse outcomes in patients with diabetic foot ulcers, yet its progression remains poorly understood. This study investigated frailty progression in patients with diabetic foot ulcers to inform targeted limb preservation strategies.

This prospective study included 178 patients with diabetic foot ulcers diagnosed within 6 months and followed for 12 months. Baseline frailty was assessed using the Clinical Frailty Scale, with patients categorized as frail or nonfrail. Frailty progression and diabetic foot ulcer-related outcomes were monitored, and logistic regression was used to identify factors associated with frailty development.

The mean age was 55.4 years; 67% of patients were female, 35% had peripheral artery disease, and 13% had end-stage kidney disease. At baseline, 42% (n = 75) were frail and 58% (n = 103) were nonfrail. All patients deemed initially frail remained frail at 12 months, whereas 25% (n = 26) of patients who were deemed nonfrail developed frailty. In multivariable logistic regression, baseline frailty was significantly associated with peripheral artery disease, myocardial infarction, and non-Hispanic ethnicity (all P < .05). In univariable logistic regression, frailty development among patients who were initially deemed nonfrail was associated with peripheral artery disease (odds ratio, 4.64; 95% confidence interval, 1.74-12.70), nonhealing ulcers (odds ratio, 2.96; 95% confidence interval, 1.20-7.63), revascularization procedures (odds ratio, 9.09; 95% confidence interval, 2.30-45.34), and diabetic foot ulcer-related hospitalizations (odds ratio, 1.96; 95% confidence interval, 1.32-3.03).

Frailty persisted among patients deemed initially frail, whereas 25% of patients who were initially deemed nonfrail developed frailty over 12 months. Future studies are needed to evaluate the role of proactive frailty screening and targeted management of risk factors to mitigate adverse outcomes among patients with diabetic foot ulcers.