{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T07:10:24Z","timestamp":1770966624429,"version":"3.50.1"},"reference-count":30,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,6,14]],"date-time":"2021-06-14T00:00:00Z","timestamp":1623628800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>We previously demonstrated in both a longitudinal study and in meta\u2010analysis (pooled relative\u2010risk RR, 2.45) that all\u2010cause mortality is significantly higher in people with diabetes foot ulceration (DFU) than with those without a foot ulcer. In this prospective study, we looked at the factors linked to mortality after presentation to podiatry with DFU.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Ninety\u2010eight individuals recruited consecutively from the Salford Royal Hospital Multidisciplinary Foot Clinic in Spring 2016 were followed up for up to 48\u00a0months. Data concerning health outcomes were extracted from the electronic patient record (EPR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventeen people (17) had type 1 diabetes mellitus, and 81 had type 2 diabetes mellitus. Thirty\u2010one were women. The mean age (range) was 63.6 (28\u201390) years with maximum diabetes duration 45\u00a0years. Mean HbA1c was 72 (95% CI: 67\u201377) mmol\/mol; 97% had neuropathy (International Working Group on the Diabetic Foot (IWGDF) monofilament); 62% had vascular insufficiency (Doppler studies); 69% of ulcers were forefoot, and 23% of ulcers were hind foot in location.<\/jats:p><jats:p>Forty of 98 (40%) patients died in follow\u2010up with 27% of death certificates including sepsis (not foot\u2010related) and 35% renal failure as cause of death. Multivariate regression analysis indicated a 6.3 (95% CI: 3.9\u20138.1) fold increased risk of death with hind foot ulcer, independent of age\/BMI\/gender\/HbA1c\/eGFR\/total cholesterol level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This prospective study has indicated a very high long\u2010term mortality rate in individuals with DFU, greater for those with a hind foot ulcer and shown a close relation between risk of sepsis\/renal failure and DFU mortality, highlighting again the importance of addressing all risk factors as soon as people present with a foot ulcer.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.14568","type":"journal-article","created":{"date-parts":[[2021,3,27]],"date-time":"2021-03-27T08:48:00Z","timestamp":1616834880000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Mortality in 98 type 1 diabetes mellitus and type 2 diabetes mellitus: Foot ulcer location is an independent risk determinant"],"prefix":"10.1111","volume":"38","author":[{"given":"Heather","family":"Schofield","sequence":"first","affiliation":[{"name":"Department of Podiatry Salford Royal Hospital Salford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha","family":"Haycocks","sequence":"additional","affiliation":[{"name":"Department of Podiatry Salford Royal Hospital Salford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology Salford Royal Hospital Salford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Edmonds","sequence":"additional","affiliation":[{"name":"Department of Diabetes King's College Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon G","family":"Anderson","sequence":"additional","affiliation":[{"name":"University of the West Indies Cavehill Campus Barbados Barbados UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9537-4050","authenticated-orcid":false,"given":"Adrian H.","family":"Heald","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology Salford Royal Hospital Salford UK"},{"name":"School of Medicine and Manchester Academic Health Sciences Centre University of Manchester Manchester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,6,14]]},"reference":[{"key":"e_1_2_11_2_1","article-title":"Diabetic foot problems: prevention and management","author":"National Institute for Health and Care Excellence","year":"2016","journal-title":"NICE guideline [NG19]"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/268390"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.12404"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.5312\/wjo.v6.i1.62"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12902-018-0327-2"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.14151"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.316.7125.100"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1464-5491.2000.00352.x"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13837"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-017-4522-x"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2017.11.063"},{"key":"e_1_2_11_13_1","unstructured":"https:\/\/www.diabetes.org.uk\/get_involved\/campaigning\/putting\u2010feet\u2010first. 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