New research published in Diabetic Medicine has shown that people with diabetes and an infected foot ulcer have worse outcomes than previously thought. In the first year after being seen at a clinic with an infected ulcer, 15.1% of study participants had died and 17.4% had had an amputation of part or all of their foot.

Diabetes mellitus, a group of diseases that affect the body’s ability to regulate blood sugar, can result in damage to several organs as well as blood vessels and nerves.

At least 3.6 million people in the UK have been diagnosed with diabetes, with another million likely to have the condition but who haven’t been diagnosed. The number of people with the diabetes is rising and is set to increase further, largely related to the growing obesity epidemic.

About a quarter of people with diabetes will develop a foot ulcer (open skin wound) as a complication of the disease. Over half of these ulcers become infected, which often requires hospital admission and may end up with a lower limb amputation. Scientists estimate that every twenty seconds, somewhere in the world a person requires a leg amputation because of diabetes.

The University of the West of England reports that a new study, led by Professor Andrea Nelson at the University of Leeds, set out to examine the outcomes for people with infected diabetic foot ulcers and the results underline the need for people at risk of foot ulcers to be closely monitored.

The researchers followed the outcomes of two hundred and ninety nine people enrolled in the study at one of twenty five centres in England. The results showed that after twelve months, the ulcer had healed in only 44.5% of the patients. This is a worse healing rate than has been observed in a comparable European multi-centre study, where 77% ulcers had healed.

This new UK study is the first to estimate the rate of healing of infected diabetic foot ulcers and to identify which factors are associated with healing, whilst accounting for potential risks of amputation and death. “Without adjusting for these events, we would have overestimated the occurrence of healing in our study by almost 10%” said the study’s Senior Statistician, Alex Wright-Hughes, based at the University of Leeds.

The three key factors that were found to be the best predictors of healing were the adequacy of the blood supply to the foot, the absence of multiple foot ulcers, and how soon the patient was referred to the clinic.

People with diabetes should have an assessment of their risk of developing a foot problem when first diagnosed, and then at least annually if any foot problems arise. This, combined with education on how to prevent or deal with a foot ulcer, can help avoid bad outcomes.

Dr Michael Backhouse, a Senior Research Fellow and podiatrist and co-author of the study, said “The results of our study are important and should help clinicians caring for patients with diabetes to identify those most at risk for poor outcomes so that we can look to provide further support.”

The UK’s National Institute for Health and Care Excellence recommends that each community have a foot protection service, led by a podiatrist with specialist training, to help prevent or treat diabetic foot problems. The goal is to not only teach patients good foot care, but what to do if they find a problem. It is particularly important that patients quickly present for treatment if they have signs of infection of the foot.

Dr Benjamin Lipsky, Professor of Medicine and infectious diseases specialist based at the University of Oxford and a study co-author, said “It is almost always infection that immediately leads to amputations. If quickly diagnosed and properly treated with antibiotics (and limited surgery), most infected ulcers can be healed.”

Dr Mwidimi Ndosi, Senior Lecturer at the University of the West of England, is the lead author of the paper and was the clinical coordinator of the study. She said “Our study recruited participants from centres ranging from large teaching hospitals to small primary healthcare clinics, so our results are likely to be representative of expected outcomes for people with diabetes and foot ulcers across England, and perhaps in other higher-income countries.”