{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:32:20Z","timestamp":1788222740773,"version":"build-2803163510"},"reference-count":27,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,6,17]],"date-time":"2019-06-17T00:00:00Z","timestamp":1560729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet. Med."],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>To ascertain the effects of improvements in diabetic foot services over 18 years on incidence of diabetic foot ulceration. We also compared survival time from first ulcer development with presence of neuropathy, peripheral vascular disease, age and healing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Persons with new ulceration and those at high risk of ulcer development were referred to community podiatry from 1998. Their details were recorded, with verbal consent, on a central database. The effects of neuropathy, peripheral vascular disease, healing and age on survival were analysed by Cox proportional hazards ratios.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The incidence of first ulcer presentation decreased from 11.1 to 6.1 per 1000 persons between 2003 to 2017 (<jats:italic>P<\/jats:italic> &lt;0.0001). Recurrent ulceration incidence remained stable. Prevalence of chronic and new foot ulceration combined increased from 20.7 to 33.1 per 1000 persons (<jats:italic>P<\/jats:italic> &lt;0.0001). Ten\u2010year survival was 85% for persons presenting with first ulcer and aged &lt;\u00a065 years, 50% for those aged 65\u201374 years and 25% for those aged 75\u201381 years (P &lt;\u00a00.0001). In those with peripheral vascular disease 5\u2010year survival was 35% (<jats:italic>P<\/jats:italic> &lt;0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Integrated care for the diabetic foot in one National Health Service (<jats:styled-content style=\"fixed-case\">NHS<\/jats:styled-content>) health service area over 18 years was associated with a reduction in first presentations of diabetic foot ulceration, but failed to reduce recurrent ulceration. Cumulative prevalence of all ulcers continues to increase. Monitoring ulceration incidence can inform audit and planning of diabetic foot care services. Survival is better than reported previously in persons &lt;\u00a065 years and in the absence of peripheral vascular disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.14045","type":"journal-article","created":{"date-parts":[[2019,5,31]],"date-time":"2019-05-31T14:23:55Z","timestamp":1559312635000},"page":"1424-1430","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Diabetic foot ulcer incidence and survival with improved diabetic foot services: an 18\u2010year study"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7790-2569","authenticated-orcid":false,"given":"R. B.","family":"Paisey","sequence":"first","affiliation":[{"name":"Torbay and South Devon Integrated Care Trust Torquay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Abbott","sequence":"additional","affiliation":[{"name":"Torbay and South Devon Integrated Care Trust Torquay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. F.","family":"Paisey","sequence":"additional","affiliation":[{"name":"West Suffolk District General Hospital Bury St Edmunds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Walker","sequence":"additional","affiliation":[{"name":"Torbay and South Devon Integrated Care Trust Torquay"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,6,17]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.1993.tb01003.x"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.22.3.382"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2005.01640.x"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc08-1242"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-011-2359-2"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12404"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13054"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-018-4723-y"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13797"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-008-1110-0"},{"key":"e_1_2_10_12_1","first-page":"2","article-title":"Recurrence of diabetic pedal ulcerations following tendo\u2010achilles lengthening","author":"Weiner RD","year":"2011","journal-title":"Diabet Foot Ankle"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.12522"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2319"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2015-000163"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-012-2468-6"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12807"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13512"},{"key":"e_1_2_10_19_1","unstructured":"NHS Digital.Spine. 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