Diabetes study halves mortality rate in foot ulcer patients

NHS Lothian researchers have developed a groundbreaking system which could halve the number of people dying from a diabetes-related condition.

Experts at the Royal Infirmary of Edinburgh have discovered that a simple system of heart monitoring combined with preventative medicine could save thousands of lives across the UK.

New research shows that patients suffering from a diabetic foot ulcer could win their battle if their heart health was also treated at the same time.

Dr Matthew Young, Consultant Physician at the Royal Infirmary of Edinburgh, said a patient’s heart held the key to their survival.

A full cardiovascular assessment was carried out on each patient to gauge their blood pressure, cholesterol and heart function before prescribing a range of protective medicines in a unique tailor-made care package.

Dr Young said:


“By applying the principles of cardiovascular risk reduction, and by learning more about a patients’ cardiac health, we were able to offer them a more specialised package of care.
“These improvements have halved this death rate to under a quarter of foot ulcer patients dying within five years of their ulcer.
“If this was repeated across Scotland it would prolong the lives of thousands of patients and tens of thousands in the UK as whole.”
The team from the Diabetic Foot Clinic at the Royal Infirmary of Edinburgh carried out the research following the introduction of the new cardiovascular policy in 2001.
Foot ulcers are known to be associated with heart disease and the experts realised that the appearance of a foot ulcer pointed to arterial damage elsewhere in the body.
They decided to give every patient, being treated after 2001, medicines to actively target heart disease even if they had no history of cardiovascular illness to protect them from future episodes.
Aspirin, statin therapy, ACE inhibitors and beta blockers were prescribed to all patients in the second group of the study.
Researchers then monitored the death rates in foot ulcer patients from both groups and compared their records.
A total of around 404 patients who developed a foot ulcer between 1995 and 1999, and around 251 patients who were diagnosed between 2001 and 2004 took part.
The experts discovered that four-year mortality was cut in half by the new policy. In group 1 the death toll was 43.3 per cent, compared with 21.9 per cent in the second group who received the heart risk assessment and treatment.
Dr Young said the cardiovascular risk management system should be rolled out in clinics across the country.


He added:
“The marked improvement in mortality in our patients occurred at a time when greater attention was given to glycaemic control, blood pressure and lipid management.
“Therefore it is most likely that the introduction of the aggressive cardiovascular risk management policy has contributed to the improvement in mortality observed.
“It suggests that diabetes foot clinics should adopt a similar policy of risk management and prescription of prevention therapies not just for those with previously known cardiovascular or blood pressure problems, but for all patients.”