ArticleDiabetes, obesity & metabolism2026
Diabetic Foot Ulcers Are Clinical Marker of Disease Burden in People With Diabetes and Heart Failure.
Article in Diabetes, obesity & metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Diabetic Foot Ulcers Are Clinical Marker of Disease Burden in People With Diabetes and Heart Failure.Diabetes, obesity & metabolism · 2026Article
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5 authors.
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No grant is acknowledged in the PubMed record.
Abstract
introductionDiabetic foot ulcers and heart failure are severe complications of diabetes mellitus, both associated with high morbidity and mortality. Whether diabetic foot ulcers worsen prognosis in people with heart failure remains unclear. This study evaluated the association between diabetic foot ulcers, mortality and heart failure hospitalisations in people with diabetes and heart failure.
methodsWe performed a retrospective cohort study including adults with diabetes and heart failure treated at a large, single centre in the Netherlands (2002-2021). People were stratified by diabetic foot ulcer status. Primary outcomes were all-cause mortality and hospitalisation for decompensated heart failure during 3 years of follow-up, with additional 5-year mortality analyses. Multivariable Cox regression was adjusted for age, renal disease, neuropathy, hypertension and other significant comorbidities. To address immortal time bias, an additional time-varying Cox model was performed.
resultsAmong 4937 people with diabetes and heart failure, 908 had a current or previous diabetic foot ulcer. These people had more comorbidities, including renal disease and neuropathy. Mortality differences were modest during the first 3 years after heart failure diagnosis but became significant at 5 years (32.0% vs. 25.1%, p < 0.001). When follow-up started at ulcer diagnosis, mortality was substantially higher in the diabetic foot ulcer group (1-year: 32.9% vs. 6.0%, p < 0.001). Multivariable analysis showed no independent association, whereas the time-varying Cox model demonstrated an independent association between diabetic foot ulcer occurrence and mortality (HR 2.88, 95% CI 2.26-3.66; p < 0.001). Hospitalization rates showed similar patterns.
conclusionsIn people with diabetes and heart failure, diabetic foot ulcer occurrence was independently associated with increased mortality in the time-varying analysis. Diabetic foot ulceration may therefore represent an important clinical marker of disease burden and identify people with advanced cardiometabolic disease who may benefit from intensified multidisciplinary management.
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