GLP-1 Receptor Agonists Are Associated With Reduced Mortality Following Diabetic Foot Ulcers: A Nationwide...

Area of Science:

• Endocrinology
• Public Health
• Gerontology

Background:

• Diabetic foot ulcers (DFU) represent a significant complication of diabetes, leading to high morbidity and mortality.
• Identifying factors associated with mortality after DFU and major lower-limb amputation is crucial for improving patient outcomes.

Purpose of the Study:

• To identify factors associated with 1-year mortality following a first diabetic foot ulcer (DFU).
• To analyze mortality after major lower-limb amputation in DFU patients within the same timeframe.

Main Methods:

• Retrospective cohort analysis of French National Health Data System (SNDS) data from January 2017 to December 2018.
• Inclusion of adults with incident DFUs, combining hospitalization and community care data, with 12 months follow-up.
• Cox proportional hazards models adjusted for demographic, clinical, treatment, and care access variables.

Main Results:

• 14.6% of 133,791 individuals with incident DFU died within 1 year; 3.5% underwent major amputation, with 28.8% of those dying within a year.
• Independent predictors of mortality included male sex, older age, hospital-acquired DFU, insulin use, major amputation, and comorbidities (cardiovascular disease, cancer, dementia, ESKD, liver disease).
• Protective factors included lipid-lowering therapy, GLP-1 receptor agonists, and prior consultations with diabetologists, ophthalmologists, and podiatrists.

Conclusions:

• One-year mortality post-DFU remains high, strongly associated with age and comorbidities.
• Community-based DFU identification reveals patient vulnerability outside hospital settings.
• GLP-1 receptor agonists and structured, multidisciplinary follow-up are linked to improved survival, highlighting the need for enhanced preventive care and optimized care pathways for high-risk diabetic populations.