Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer.
Open accessAbstract
BACKGROUND: In 2007, we reported a summary of data comparing diabetic foot complications to cancer. The purpose of this brief report was to refresh this 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. METHODS: We collected data reporting 5-year mortality from studies published following 2007 and calculated a pooled mean. We evaluated data from DFU, Charcot arthropathy and lower extremity amputation. We 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. RESULTS: 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. CONCLUSION: 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.
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The diagnosis of diabetic foot infection is primarily based on clinical assessment and is suggested by presence of more than 2 signs of inflammation, such as erythema, swelling and possibly purulence, fluctuance, or lymphangiitis.
“The diagnosis of diabetic foot infection is primarily based on clinical assessment and is suggested by presence of more than 2 signs of inflammation, such as erythema, swelling and possibly purulence, fluctuance, or lymphangiitis.7,13”
From Diabetic Foot Ulcers (2023) · cites this paper as [7]
The Conclusion discusses how often diabetic foot ulcers become infected, but not how infection is diagnosed. A search for clinical assessment, signs of inflammation, and the named signs found no diagnostic criteria in our copy; the References list an infection guideline without stating its criteria. (LLM, conf=0.75)
Experimental — accuracy not yet measuredRandomized clinical trial data are not available to support obtaining wound cultures from all patients with diabetic foot ulcers.
“Randomized clinical trial data are not available to support obtaining wound cultures from all patients with diabetic foot ulcers.7,13”
From Diabetic Foot Ulcers (2023) · cites this paper as [7]
The paper’s Methods section describes pooling five-year mortality data and comparing them with cancer mortality; the economic-cost section discusses ulcer detection technologies. Searches for wound cultures and randomized clinical trial evidence found no passage addressing whether all patients with diabetic foot ulcers should have wound cultures obtained. No page numbers were provided for these sections. (LLM, conf=0.73)
Experimental — accuracy not yet measuredFor diagnosing osteomyelitis, bone biopsy and culture remain the gold standard.
“For diagnosing osteomyelitis, bone biopsy and culture remain the gold standard.7,13”
From Diabetic Foot Ulcers (2023) · cites this paper as [7]
The Methods section (page unavailable) describes pooling five-year mortality data for diabetic foot complications and comparing them with cancer mortality. Neither the supplied passages nor searches for bone biopsy, culture, and osteomyelitis diagnosis found a passage addressing the claimed diagnostic gold standard. (LLM, conf=0.75)
Experimental — accuracy not yet measuredMagnetic resonance imaging has shown consistent accuracy in identifying osteomyelitis (likelihood ratio, 3.6; sensitivity, 93%; specificity, 75%), particularly when the clinical assessment and plain x-ray findings are equivocal.
“Magnetic resonance imaging has shown consistent accuracy in identifying osteomyelitis (likelihood ratio, 3.6; sensitivity, 93%; specificity, 75%), particularly when the clinical assessment and plain x-ray findings are equivocal, and may be helpful in identifying occult abscesses or determining the extent of deeper infections.7,43”
From Diabetic Foot Ulcers (2023) · cites this paper as [7]
The Methods section (page unavailable) describes pooling five-year mortality data for diabetic foot complications and comparing them with cancer mortality. Searches for MRI, osteomyelitis, the stated accuracy figures, and equivocal clinical or x-ray findings found no passage in our copy addressing the imaging claim. (LLM, conf=0.75)
Experimental — accuracy not yet measuredIn the absence of an acute soft tissue infection in forefoot osteomyelitis, antibiotics may be as effective as surgery.
“In the absence of an acute soft tissue infection in forefoot osteomyelitis, antibiotics may be as effective as surgery.7”
From Diabetic Foot Ulcers (2023) · cites this paper as [7]
The paper’s Conclusion discusses mortality, recurrence, and prevention of diabetic foot complications, not treatment of forefoot osteomyelitis. Searches for forefoot osteomyelitis, acute soft-tissue infection, and antibiotics versus surgery found no passage addressing their comparative effectiveness. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Self-citation
- Authors
- Armstrong, D. G., Swerdlow, M. A., Armstrong, A. A., Conte, M. S., Padula, W. V., & Bus, S. A.
- Affiliations
- University of Southern California (US)
- Corresponding author
- Armstrong, David G.
- Venue
- Journal of Foot and Ankle Research
- Publisher
- Wiley
- Published
- 2020-01
- Volume
- 13
- Issue
- 1
- Pages
- 16-16
- ISSN
- 1757-1146 (ISSN-L)
- PMC
- PMC7092527
- OpenAlex
- W3013389260
- Cited by
- 975
- References
- 40
- Citations by year
- 2026: 173 · 2025: 213 · 2024: 200 · 2023: 153 · 2022: 129 · 2021: 84 · 2020: 23
- FWCI
- 73.34
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Foot and Ankle Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Funders
- National Institutes of Health (UL1TR001855)
- National Center for Advancing Translational Sciences
- 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 complications, diabetic foot ulcer, Charcot foot, lower limb amputation, 5-year mortality, diabetes burden, primary prevention
- MeSH terms
- Amputation, Surgical, Arthropathy, Neurogenic, Humans, Neoplasms, Health Care Costs, Diabetic Foot, Lower Extremity
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