{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:54:25Z","timestamp":1788173665576,"version":"build-2803163510"},"reference-count":52,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,12,2]],"date-time":"2019-12-02T00:00:00Z","timestamp":1575244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet. Med."],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Diabetic foot ulcers portend an almost twofold increase in all\u2010cause mortality compared with diabetes on its own.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To investigate the association between diabetic foot ulcers and risk of death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a meta\u2010analysis of all\u00a0observational studies investigating the association between diabetic foot ulcers and all\u2010cause mortality. Risk ratios and risk differences were pooled in a random\u2010effects model.\u00a0The <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> statistic was used to quantify heterogeneity between studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Altogether, we identified 11 studies that reported 84 131 deaths from any cause in 446 916 participants with diabetes during a total of 643 499 person\u2010years of follow\u2010up. The crude event rate for all\u2010cause mortality in individuals with diabetes who did not develop foot ulceration was 22% lower at 181.5 deaths (per 1000 person\u2010years) than in those who developed foot ulcers (230.8 per 1000 person\u2010years). Diabetic foot ulceration was associated with an increased risk of all\u2010cause mortality (pooled relative risk 2.45, 95% CI 1.85\u20132.85). We did not observe any tangible differences in risk of all\u2010cause mortality from diagnosis in studies reporting a mean duration of follow\u2010up of \u22643 years (relative risk 2.43, 95% CI 2.27\u20132.61) or &gt;3 years (relative risk 2.26, 95% CI 2.13\u20132.40) years. Funnel plot inspection revealed no significant publication bias among studies included in this meta\u2010analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our study shows an excess rate of all\u2010cause mortality in people with diabetic foot ulceration when compared to those without foot ulceration. It is imperative that early interventions to prevent foot ulceration and modify cardiovascular disease risk factors are put in place to reduce excess mortality.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.14151","type":"journal-article","created":{"date-parts":[[2019,10,15]],"date-time":"2019-10-15T22:12:10Z","timestamp":1571177530000},"page":"211-218","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":122,"title":["Foot ulceration and its association with mortality in diabetes mellitus: a meta\u2010analysis"],"prefix":"10.1111","volume":"37","author":[{"given":"S.","family":"Saluja","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Sciences Faculty of Biology, Medicine and Health University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. G.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Sciences Faculty of Biology, Medicine and Health University of Manchester Manchester UK"},{"name":"George Alleyne Chronic Disease Research Centre University of the West Indies Cavehill Barbados"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Hambleton","sequence":"additional","affiliation":[{"name":"George Alleyne Chronic Disease Research Centre University of the West Indies Cavehill Barbados"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Shoo","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrine Department Countess of Chester NHS Foundation Trust Chester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Livingston","sequence":"additional","affiliation":[{"name":"Department of Blood Sciences Walsall Manor Hospital Walsall UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. 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