{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T04:53:09Z","timestamp":1789102389859,"version":"build-2803163510"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,10,22]],"date-time":"2021-10-22T00:00:00Z","timestamp":1634860800000},"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":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>A diabetic foot ulcer (DFU) is a severe condition associated with morbidity and mortality. Population\u2010based studies are rare and limited by access to reliable data. Without this data, efforts in primary prevention cannot be evaluated. Therefore, we examined the incidence and changes over time for the first DFU in people with diabetes. We also examined hospitalization and all\u2010cause mortality and their changes over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From the UK primary care CPRD GOLD database (2007\u20132017), we identified 129,624 people with diabetes by a prescription for insulin or a non\u2010insulin anti\u2010diabetic drug. DFUs were identified using Read codes and expressed as incidence rates (IRs). Changes over time were described using Poisson and logistic regression and expressed as incidence rate ratios (IRRs) and odds ratios (ORs) respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean IR of first registered DFUs was 2.5 [95% CI: 2.1\u20132.9] per 1000 person\u2010years for people with type 2 diabetes and 1.6 [1.3\u20131.9] per 1000 person\u2010years for people with type 1. The IRs declined for people with type 2 diabetes (IRR per year: 0.97 [0.96\u20130.99]), while no changes were observed for people with type 1 diabetes (IRR per year: 0.96 [0.89\u20131.04]). Average hospitalization and 1\u2010year mortality risk for people with type 2 diabetes were 8.2% [SD: 4.7] and 11.7% [SD: 2.2] respectively. Both declined over time (OR: 0.89 [0.84, 0.94] and 0.94 [0.89, 0.99]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The decline in all IRs, hospitalizations and mortality in people with type 2 diabetes suggests that prevention and care of the first DFU has improved for this group in primary care in the UK.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.14725","type":"journal-article","created":{"date-parts":[[2021,10,21]],"date-time":"2021-10-21T00:45:08Z","timestamp":1634777108000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Incidence, hospitalization and mortality and their changes over time in people with a first ever diabetic foot ulcer"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4578-1328","authenticated-orcid":false,"given":"Johan","family":"R\u00f8ikjer","sequence":"first","affiliation":[{"name":"Steno Diabetes Center North Denmark Aalborg University Hospital  Aalborg Denmark"},{"name":"Department of Health Science and Technology Aalborg University  Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikki C. C.","family":"Werkman","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute Maastricht (CARIM)  Maastricht the Netherlands"},{"name":"Department of Clinical Pharmacy and Toxicology Maastricht University medical Centre+  Maastricht the Netherlands"},{"name":"Division of Pharmacoepidemiology &amp; Clinical Pharmacology Utrecht Institute for Pharmaceutical Sciences Utrecht University  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3749-3403","authenticated-orcid":false,"given":"Niels","family":"Ejskjaer","sequence":"additional","affiliation":[{"name":"Steno Diabetes Center North Denmark Aalborg University Hospital  Aalborg Denmark"},{"name":"Clinical Medicine and Endocrinology Aalborg University Hospital  Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joop P. W.","family":"van den Bergh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Maastricht University Medical Centre  Maastricht the Netherlands"},{"name":"Department of Internal Medicine VieCuri Medical Centre  Venray the Netherlands"},{"name":"Biomedical Research Centre Hasselt University  Hasselt Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Vestergaard","sequence":"additional","affiliation":[{"name":"Steno Diabetes Center North Denmark Aalborg University Hospital  Aalborg Denmark"},{"name":"Clinical Medicine and Endocrinology Aalborg University Hospital  Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2128-8029","authenticated-orcid":false,"given":"Nicolaas C.","family":"Schaper","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute Maastricht (CARIM)  Maastricht the Netherlands"},{"name":"Division of Endocrinology Department of Internal Medicine Maastricht University Medical Centre  Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6649-8644","authenticated-orcid":false,"given":"Morten Hasselstr\u00f8m","family":"Jensen","sequence":"additional","affiliation":[{"name":"Steno Diabetes Center North Denmark Aalborg University Hospital  Aalborg Denmark"},{"name":"Department of Health Science and Technology Aalborg University  Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olaf","family":"Klungel","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology &amp; Clinical Pharmacology Utrecht Institute for Pharmaceutical Sciences Utrecht University  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3837-8319","authenticated-orcid":false,"given":"Frank","family":"de Vries","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute Maastricht (CARIM)  Maastricht the Netherlands"},{"name":"Department of Clinical Pharmacy and Toxicology Maastricht University medical Centre+  Maastricht the Netherlands"},{"name":"Division of Pharmacoepidemiology &amp; Clinical Pharmacology Utrecht Institute for Pharmaceutical Sciences Utrecht University  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes T. 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