{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T19:22:42Z","timestamp":1787599362975,"version":"build-2736575974"},"reference-count":46,"publisher":"Wiley","license":[{"start":{"date-parts":[[2022,6,14]],"date-time":"2022-06-14T00:00:00Z","timestamp":1655164800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NHS Research Scotland","award":["765141"],"award-info":[{"award-number":["765141"]}]},{"name":"European Union Research Framework Programme Horizon 2020","award":["765141"],"award-info":[{"award-number":["765141"]}]},{"name":"Marie Sk\u0142odowska-Curie Innovative Training Network","award":["765141"],"award-info":[{"award-number":["765141"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Diabetes Research"],"published-print":{"date-parts":[[2022,6,14]]},"abstract":"<jats:p>Aims. To compare different packages of care across care providers in Scotland on foot-related outcomes. Methods. A retrospective cohort study with primary and secondary care electronic health records from the Scottish Diabetes Registry, including 6,845 people with type 2 diabetes and a first foot ulcer occurring between 2013 and 2017. We assessed the association between exposure to care processes and major lower extremity amputation and death. Proportional hazards were used for time-to-event univariate and multivariate analyses, adjusting for case-mix characteristics and care processes. Results were expressed in terms of hazard ratios with 95% confidence intervals. Results. 2,243 (32.7%) subjects had a major amputation or death. Exposure to all nine care processes at all ages (<jats:inline-formula>\n                     <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:mtext>HR<\/a:mtext>\n                        <a:mo>=<\/a:mo>\n                        <a:mn>0.63<\/a:mn>\n                     <\/a:math>\n                  <\/jats:inline-formula>; 95% CI: 0.58-0.69; <jats:inline-formula>\n                     <c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\">\n                        <c:mi>p<\/c:mi>\n                        <c:mo>&lt;<\/c:mo>\n                        <c:mn>.001<\/c:mn>\n                     <\/c:math>\n                  <\/jats:inline-formula>) and higher foot care attendance in people aged &gt;70 years (<jats:inline-formula>\n                     <e:math xmlns:e=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\">\n                        <e:mtext>HR<\/e:mtext>\n                        <e:mo>=<\/e:mo>\n                        <e:mn>0.88<\/e:mn>\n                     <\/e:math>\n                  <\/jats:inline-formula>; 0.78-0.99; <jats:inline-formula>\n                     <g:math xmlns:g=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M4\">\n                        <g:mi>p<\/g:mi>\n                        <g:mo>=<\/g:mo>\n                        <g:mn>.03<\/g:mn>\n                     <\/g:math>\n                  <\/jats:inline-formula>) were associated with longer major amputation-free survival. <jats:inline-formula>\n                     <i:math xmlns:i=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M5\">\n                        <i:mtext>Waiting<\/i:mtext>\n                        <i:mtext>\u2009<\/i:mtext>\n                        <i:mtext>time<\/i:mtext>\n                        <i:mo>\u2265<\/i:mo>\n                        <i:mn>12<\/i:mn>\n                     <\/i:math>\n                  <\/jats:inline-formula> weeks between ulceration and clinic attendance was associated with worse outcomes (<jats:inline-formula>\n                     <k:math xmlns:k=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M6\">\n                        <k:mtext>HR<\/k:mtext>\n                        <k:mo>=<\/k:mo>\n                        <k:mn>1.59<\/k:mn>\n                     <\/k:math>\n                  <\/jats:inline-formula>; 1.37-1.84; <jats:inline-formula>\n                     <m:math xmlns:m=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M7\">\n                        <m:mi>p<\/m:mi>\n                        <m:mo>&lt;<\/m:mo>\n                        <m:mn>.001<\/m:mn>\n                     <\/m:math>\n                  <\/jats:inline-formula>). In <jats:inline-formula>\n                     <o:math xmlns:o=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M8\">\n                        <o:mtext>people<\/o:mtext>\n                        <o:mo>&gt;<\/o:mo>\n                        <o:mn>70<\/o:mn>\n                     <\/o:math>\n                  <\/jats:inline-formula> years, minor amputations were associated with improved major amputation-free survival (<jats:inline-formula>\n                     <q:math xmlns:q=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M9\">\n                        <q:mtext>HR<\/q:mtext>\n                        <q:mo>=<\/q:mo>\n                        <q:mn>0.69<\/q:mn>\n                     <\/q:math>\n                  <\/jats:inline-formula>; 0.52-0.92; <jats:inline-formula>\n                     <s:math xmlns:s=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M10\">\n                        <s:mi>p<\/s:mi>\n                        <s:mo>=<\/s:mo>\n                        <s:mn>.01<\/s:mn>\n                     <\/s:math>\n                  <\/jats:inline-formula>). Conclusions. Strict adherence to a standardised package of general diabetes care before foot ulceration, timely foot care after ulceration, and specific treatment pathways were associated with longer major amputation-free survival among a large cohort of people with type 2 diabetes in Scotland, with a larger impact on older age groups.<\/jats:p>","DOI":"10.1155\/2022\/7414258","type":"journal-article","created":{"date-parts":[[2022,6,14]],"date-time":"2022-06-14T15:35:30Z","timestamp":1655220930000},"page":"1-13","source":"Crossref","is-referenced-by-count":9,"title":["Adherence to General Diabetes and Foot Care Processes, with Prompt Referral, Are Associated with Amputation-Free Survival in People with Type 2 Diabetes and Foot Ulcers: A Scottish National Registry Analysis"],"prefix":"10.1155","volume":"2022","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6551-5484","authenticated-orcid":true,"given":"Bernardo","family":"Meza-Torres","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Surrey, UK"},{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0861-8676","authenticated-orcid":true,"given":"Scott G.","family":"Cunningham","sequence":"additional","affiliation":[{"name":"Division of Population Health and Genomics, University of Dundee, Scotland, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3212-8995","authenticated-orcid":true,"given":"Christian","family":"Heiss","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Surrey, UK"},{"name":"Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Redhill, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4974-3724","authenticated-orcid":true,"given":"Mark","family":"Joy","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0631-6199","authenticated-orcid":true,"given":"Michael","family":"Feher","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham P.","family":"Leese","sequence":"additional","affiliation":[{"name":"Division of Population Health and Genomics, University of Dundee, Scotland, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8553-2641","authenticated-orcid":true,"given":"Simon","family":"de Lusignan","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7524-227X","authenticated-orcid":true,"given":"Fabrizio","family":"Carinci","sequence":"additional","affiliation":[{"name":"Department of Statistical Sciences, University of Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13973"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1615439"},{"issue":"1","key":"3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13047-020-00383-2","article-title":"Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer","volume":"13","author":"D. 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