Age-related variations in clinical characteristics of patients with diabetic foot ulcers

Diabetic foot ulcers (DFUs) have increasingly affected younger populations. This study aimed to analyze the clinical characteristics of DFUs in different age groups of diabetic patients with foot ulcers.

This is a retrospective cohort study of diabetic patients with foot ulcers admitted to West China Hospital, Sichuan University. They were divided into the young (<45 years), the middle-aged (45-64 years), and the elderly groups (≥65 years). The patients were followed up for a median of 44.5 months, either at the outpatient department or by phone.

This study enrolled 1,209 patients with DFUs, stratified into three groups according to age: young (n = 65), middle-aged (n = 509), and elderly (n = 635). All patients had a long history of diabetes with an average duration of 11.5 years. The DFU patients of all ages have poor glycemic control. About one-third of the patients have recurrent foot ulcers. The prevalence of comorbidities such as hypertension, coronary artery disease, chronic kidney disease, and peripheral artery disease increased significantly with age (P < 0.001). Neuropathic foot ulcers were more common in the young patients (48.3%), whereas neuro-ischemic ulcers were more prevalent in the middle-aged (42.1%) and elderly patients (56.9%). Compared with the young (27.7%) and middle-aged patients (26.9%), the ulcer healing rates during hospitalization were significantly lower in the elderly patients (18.9%, P = 0.004). During a median 44.5 (IQR 18.7-74.5)-month follow-up period, 375 (36.2%) deaths occurred, and all-cause mortality increased significantly with age (P < 0.001).

Clinical characteristics of DFUs are profoundly age-dependent: younger patients exhibited poorer glycemic control, neuropathic ulcers, and mechanical injuries, while the older patients developed more vascular complications and neuro-ischemic ulcers. Therefore, different prevention and treatment measures should be taken for DFUs based on their clinical characteristics in different age groups.