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Diabetic Foot Ulcers Are Clinical Marker of Disease Burden in People With Diabetes and Heart Failure

A Rumanes1, G C M Linssen2, J J van Netten3,4

  • 1Department of Surgery, Ziekenhuisgroep Twente (ZGT), Almelo, the Netherlands.

Diabetes, Obesity & Metabolism
|July 21, 2026
PubMed

Insights

Diabetic foot ulcers significantly increase mortality risk in patients with heart failure. Early identification and intensive management are crucial for this high-risk population.

Area of Science:

  • Cardiology
  • Endocrinology
  • Diabetology

Background:

  • Diabetic foot ulcers (DFU) and heart failure (HF) are serious diabetes complications.
  • Both conditions are linked to high morbidity and mortality.
  • The impact of DFU on HF prognosis is not well understood.

Purpose of the Study:

  • To evaluate the association between DFU and mortality/HF hospitalizations in diabetes patients with HF.
  • To identify DFU as a potential marker for advanced cardiometabolic disease.

Main Methods:

  • Retrospective cohort study of 4937 adults with diabetes and HF (2002-2021).
  • Stratification by DFU status; primary outcomes: 3-year all-cause mortality and HF hospitalization.
  • Time-varying Cox regression used to address immortal time bias.

Main Results:

  • 908/4937 patients had DFU, presenting with more comorbidities.
  • 5-year mortality was significantly higher in the DFU group (32.0% vs. 25.1%).
  • Time-varying analysis revealed an independent association between DFU and mortality (HR 2.88).

Conclusions:

  • DFU occurrence is independently associated with increased mortality in diabetes patients with HF.
  • DFU may indicate advanced disease burden and identify patients needing intensified management.
  • DFU warrants consideration as a clinical marker in managing complex cardiometabolic disease.
Abstract

Keywords:
cohort studydiabetes complicationsheart failurereal‐world evidence

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