Guest Editorial: are diabetes‐related wounds and amputations worse than cancer?
Open accessAbstract
Certainly one of the most feared complications of diabetes is the lower extremity amputation 1. This fear is not unwarranted. Diabetes-related ulcer and amputation may be associated with surprisingly high 5-year mortality. Moulik et al.2 reported a 5-year mortality of 45%, 18% and 55% for neuropathic, neuroischaemic and ischaemic ulcers, respectively. As expected, mortality was higher in ischaemic ulcers than neuropathic ulcers. However, it is fairly evident based on these data that all types of diabetic foot ulcers are associated with high morbidity and mortality. Similarly, approximately half the persons receiving a diabetes-related amputation will not be alive in 5 years. Certainly, peripheral vascular disease may be implicated as a significant factor associated with shorter life span. Criqui reported the 10-year mortality in patients with peripheral arterial disease and found a substantially higher risk of mortality among patients with large vessel peripheral arterial disease – a factor that may be even more profound today than when it was reported in the early 1990s 3, 4. Faglia et al. related this high mortality with the absence of revascularisation, citing a 1.7-fold greater risk for death in ischaemic subjects who might have benefited from intervention 5. How do these data compare with other serious medical conditions, such as cancer? If one reviews Figure 1, one might conclude that persons with lower extremity complications of diabetes have 5-year mortality rates similar or worse than many common types of cancer 6-10. In fact, some high-risk subgroups such as persons with renal disease requiring distal bypass may have 5-year mortality rates approaching 95% 10. Five-year mortality (%). Perhaps now is the time to change our discussion with health-care administrators, policy makers and especially ourselves. The disease state that many of us treat routinely is, quite literally, killing our patients at a rate comparable to cancer. Addressing this issue aggressively may alter this and make a difference for millions of people worldwide.
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Chronic wound repair is a mortal disease similar to cancer.
“Perhaps, it is now the time to recognize that chronic wound repair is a mortal disease similar to cancer (11).”
From Wound repair and regeneration: Mechanisms, signaling, and translation (2014) · cites this paper as [11]
The 5-year mortality rate for patients with diabetic foot ulcers or ischemic ulcers is much higher than that of prostate or breast cancer.
“Although not an immediately obvious concept, the 5-year mortality rate for patients suffering from DFU or ischemic ulcers is much higher than that of prostate or breast cancer (11-13).”
From Wound repair and regeneration: Mechanisms, signaling, and translation (2014) · cites this paper as [11]
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The diabetic rapid response acute foot team: 7 essential skills for targeted limb salvage.
Fitzgerald, R. H., Mills, J. L., Joseph, W. S., & Armstrong, D. G. (2009) · PubMed Central · Cited by 54 · see citing works
Self-citationUS – N ational I nstitutes of H ealth‐funded research for cutaneous wounds in 2012
Richmond, N. A., Lamel, S. A., Davidson, J. M., Martins‐Green, M. M., Sen, C. K., Tomic‐Canic, M., Vivas, A. C., Braun, L. R., & Kirsner, R. S. (2013) · Wound Repair and Regeneration · doi:10.1111/wrr.12099 · Cited by 54 · see citing works
Wherefore Art Thou, O Treatment for Diabetic Neuropathy?
Malik, R. A. (2016) · International review of neurobiology · doi:10.1016/bs.irn.2016.03.008 · Cited by 54 · see citing works
Ulcer metastasis? anatomical locations of recurrence for patients in diabetic foot remission.
Petersen, B. J., Rothenberg, G. M., Lakhani, P. J., Zhou, M., Linders, D. R., Bloom, J. D., Wood, K. A., & Armstrong, D. G. (2020) · Journal of Foot and Ankle Research · doi:10.1186/s13047-020-0369-3 · Cited by 53 · see citing works
Self-citationYang, H., Fierro, F. A., So, M., Yoon, D. J., Nguyen, A. V., Gallegos, A., Bagood, M. D., Rojo-Castro, T., Alex, A., Stewart, H., et al. (2020) · Stem Cells Translational Medicine · doi:10.1002/sctm.19-0380 · Cited by 52 · see citing works
Campbell, A. E., McCready-Vangi, A. R., Uberoi, A., Murga-Garrido, S. M., Lovins, V. M., White, E. K., Pan, J. T.-C., Knight, S. A. B., Morgenstern, A. R., Bianco, C. M., et al. (2023) · Cell Reports · doi:10.1016/j.celrep.2023.113281 · Cited by 51 · see citing works
Ikura, K., Hanai, K., Shinjo, T., & Uchigata, Y. (2015) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2015.02.006 · Cited by 52 · see citing works
Jia, H., Wang, X., & Cheng, J. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.876105 · Cited by 50 · see citing works
Ojalvo, A. G., Acosta, J. B., Mendoza‐Marí, Y., Fernández‐Mayola, M., Pérez, C. V., Gutiérrez, W. S., Marichal, I. I., Seijas, E. Á., Kautzman, A. M., Pacheco, A. E., et al. (2016) · International Wound Journal · doi:10.1111/iwj.12592 · Cited by 50 · see citing works
Self-citationReview of near-infrared methods for wound assessment
Sowa, M. G., Kuo, W., Ko, A. C. ‐., & Armstrong, D. G. (2016) · Journal of Biomedical Optics · doi:10.1117/1.jbo.21.9.091304 · Cited by 52 · see citing works
Self-citationPedras, S., Carvalho, R., & Pereira, M. G. (2016) · Journal of Health Psychology · doi:10.1177/1359105316656769 · Cited by 50 · see citing works
Clinical profile and outcome in patients of diabetic foot infection
Seth, A., Attri, A., Kataria, H., Kochhar, S., Seth, S., & Gautam, N. (2019) · International Journal of Applied and Basic Medical Research · doi:10.4103/ijabmr.ijabmr_278_18 · Cited by 50 · see citing works
Quinton, T. R., Lazzarini, P. A., Boyle, F. M., Russell, A. W., & Armstrong, D. G. (2015) · Journal of Foot and Ankle Research · doi:10.1186/s13047-015-0072-y · Cited by 49 · see citing works
Self-citationSkrepnek, G. H., Armstrong, D. G., & Mills, J. L. (2014) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2014.04.071 · Cited by 49 · see citing works
Self-citationNiederauer, M. Q., Michalek, J. E., & Armstrong, D. G. (2017) · Journal of Diabetes Science and Technology · doi:10.1177/1932296817695574 · Cited by 49 · see citing works
Self-citationMortality prediction following non-traumatic amputation of the lower extremity
Norvell, D. C., Thompson, M. L., Boyko, E. J., Landry, G. J., Littman, A. J., Henderson, W. G., Turner, A. P., Maynard, C. C., Moore, K. P., & Czerniecki, J. M. (2019) · British journal of surgery · doi:10.1002/bjs.11124 · Cited by 48 · see citing works
Wound Inflammatory Index: A “Proof of Concept” Study to Assess Wound Healing Trajectory
Bharara, M., Schoess, J. N., Nouvong, A., & Armstrong, D. G. (2010) · Journal of Diabetes Science and Technology · doi:10.1177/193229681000400402 · Cited by 48 · see citing works
Self-citationMarkanday, A. (2014) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofu060 · Cited by 47 · see citing works
Thewjitcharoen, Y., Krittiyawong, S., Porramatikul, S., Parksook, W., Chatapat, L., Watchareejirachot, O., Sripatpong, J., & Himathongkam, T. (2014) · Journal of Clinical & Translational Endocrinology · doi:10.1016/j.jcte.2014.10.002 · Cited by 46 · see citing works
Risk factors for lower extremity amputation among patients with diabetes in Singapore
Yang, Y., Østbye, T., Tan, S. B., Salam, Z.-H. A., Ong, B. C., & Yang, K. S. (2011) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2011.08.002 · Cited by 45 · see citing works
- Authors
- Armstrong, D. G., Wrobel, J., & Robbins, J. M.
- Affiliations
- Rosalind Franklin University of Medicine and Science (US)
- ORCID
- Armstrong, David G
- Venue
- International Wound Journal
- Publisher
- Wiley
- Published
- 2007-12
- Volume
- 4
- Issue
- 4
- Pages
- 286-287
- ISSN
- 1742-4801 (ISSN-L)
- 1742-481X
- OpenAlex
- W1987246200
- Cited by
- 456
- References
- 9
- Citations by year
- 2026: 13 · 2025: 28 · 2024: 31 · 2023: 28 · 2022: 21 · 2021: 41 · 2020: 48 · 2019: 37 · 2018: 30 · 2017: 31 · 2016: 37 · 2015: 21 · 2014: 21 · 2013: 19 · 2012: 16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Wound Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Dermatology › Skin Diseases and Diabetes
- Keywords
- diabetic foot ulcer, lower limb amputation, diabetes mortality, peripheral arterial disease, revascularization, ischemic ulcers, neuropathic ulcer, kidney disease, distal bypass, health policy
- MeSH terms
- Amputation, Surgical, Diabetic Angiopathies, Female, Humans, Male, Neoplasms, Sensitivity and Specificity, Wound Healing, Survival Analysis, Treatment Outcome, Diabetic Foot, Sickness Impact Profile, Risk Assessment, Lower Extremity, Diabetes Complications
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