October 2020

5-year Mortality, Costs of Diabetic Foot Complications Comparable to Cancer

Five Year Mortality of Diabetic Foot Complications and Cancer. Diabetic foot complications compared to cancer. DFU = diabetic foot ulcers = 30.5%. Charcot = Charcot neuroarthropathy of the foot. All Cancer = pooled 5-year survival of all cancers. CLTI = chronic limb threatening ischemia. Major Amputation = above foot amputation. Minor Amputation = foot level amputation. Use is per the Creative Commons License 4.0.

The purpose of this brief report was to refresh a 2007 data summary comparing diabetic foot complications to cancer with the best available data as they currently exist. Since that time, more reports have emerged both on cancer mortality and mortality associated with diabetic foot ulcer (DFU), Charcot arthropathy, and diabetes-associated lower extremity amputation.

These investigators collected data reporting 5-year mortality from studies published following 2007 and calculated a pooled mean. They evaluated data from DFU, Charcot arthropathy, and lower extremity amputation, and then dichotomized high and low amputation as proximal and distal to the ankle, respectively. This was compared with cancer mortality as reported by the American Cancer Society and the National Cancer Institute.

Five-year mortality for Charcot, DFU, minor and major amputations were 29.0, 30.5, 46.2 and 56.6%, respectively. This is compared to 9.0% for breast cancer and 80.0% for lung cancer. 5 year pooled mortality for all reported cancer was 31.0%. Direct costs of care for diabetes in general was $237 billion in 2017. This is compared to $80 billion for cancer in 2015. As up to one-third of the direct costs of care for diabetes may be attributed to the lower extremity, these are also readily comparable.

Diabetic lower extremity complications remain enormously burdensome. Most notably, DFU and LEA appear to be more than just a marker of poor health. They are independent risk factors associated with premature death. While advances continue to improve outcomes of care for people with DFU and amputation, efforts should be directed at primary prevention as well as those for patients in diabetic foot ulcer remission to maximize ulcer-free, hospital-free and activity-rich days.

Source: Armstrong DG, Swerdlow MA, Armstrong AA, et al. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res. 2020;13:16.

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