{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:12:00Z","timestamp":1793394720062,"version":"4.5.0"},"reference-count":40,"publisher":"American Diabetes Association","issue":"1","license":[{"start":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T00:00:00Z","timestamp":1636934400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/content\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,1,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>To describe incidence of foot ulceration and amputation-free survival associated with foot ulceration status in a national population-based cohort study of people with diabetes.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESEARCH DESIGN AND METHODS<\/jats:title><jats:p>The study population included 233,459 people with diabetes who were alive in Scotland on 1 January 2012 identified from the national population-based register (national prevalence 4.9%). Characteristics of patients identified from linked hospital and mortality records during follow-up to the end of November 2017 were compared by outcome. Cox regression was used to assess the association between history of foot ulcer and amputation-free survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The population included 23,395 people with type 1 diabetes and 210,064 people with type 2 diabetes. In total there were 13,093 (5.6%) people who had a previous foot ulceration, 9,023 people who developed a first ulcer, 48,995 who died, and 2,866 who underwent minor or major amputation during follow-up. Overall incidence of first-time foot ulcers was 7.8 per 1,000 person-years (95% CI7.6\u20137.9) and 11.2 (11.0\u201311.4) for any ulcer. Risk factors for reduced amputation-free survival included social deprivation, mental illness, and being underweight in addition to conventional cardiovascular risk factors. Adjusted hazard ratios (95% CI) were 2.09 (1.89\u20132.31) for type 1 diabetes and 1.65 (1.60\u20131.70) for type 2 diabetes.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The overall incidence of foot ulceration in a population-based study of people with diabetes was 11.2 per 1,000 person-years. Foot ulceration is associated with lower amputation-free survival rate, a potential measure of effectiveness of care among people with diabetes. Mental illness and social deprivation are also highlighted as risk factors.<\/jats:p><\/jats:sec>","DOI":"10.2337\/dc21-1596","type":"journal-article","created":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T23:40:11Z","timestamp":1637019611000},"page":"83-91","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":97,"title":["Foot Ulcer and Risk of Lower Limb Amputation or Death in People With Diabetes: A National Population-Based Retrospective Cohort Study"],"prefix":"10.2337","volume":"45","author":[{"given":"Rosemary C.","family":"Chamberlain","sequence":"first","affiliation":[{"name":"1Department of Diabetes and Endocrinology, Ninewells Hospital, Dundee, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Fleetwood","sequence":"additional","affiliation":[{"name":"2Usher Institute, University of Edinburgh, Edinburgh, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7824-2569","authenticated-orcid":false,"given":"Sarah H.","family":"Wild","sequence":"additional","affiliation":[{"name":"3Usher Institute, University of Edinburgh, Edinburgh, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8345-3288","authenticated-orcid":false,"given":"Helen M.","family":"Colhoun","sequence":"additional","affiliation":[{"name":"4Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S.","family":"Lindsay","sequence":"additional","affiliation":[{"name":"5Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4894-9819","authenticated-orcid":false,"given":"John R.","family":"Petrie","sequence":"additional","affiliation":[{"name":"6Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3957-1981","authenticated-orcid":false,"given":"Rory J.","family":"McCrimmon","sequence":"additional","affiliation":[{"name":"7School of Medicine, University of Dundee, Dundee, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5576-6463","authenticated-orcid":false,"given":"Fraser","family":"Gibb","sequence":"additional","affiliation":[{"name":"8Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Edinburgh, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Philip","sequence":"additional","affiliation":[{"name":"9Diabetes Centre, Aberdeen Royal Infirmary, Aberdeen, 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