Response to Comment on Hoffstad et al. Diabetes, Lower-Extremity Amputation, and Death. Diabetes Care 2015;38:1852–1857

We thank Uccioli et al. (1) for their interest in our study (2). We greatly appreciate their kind words about the importance of our study. Their review of their investigations on risk factors for amputation for patients with diabetes and critical limb ischemia seen in a tertiary referral diabetic foot clinic (3) and the follow-up study (4) that was recently electronically published is interesting. We certainly agree with the message of their letter that it is important for care providers to communicate with patients who have diabetes and a foot ulcer about the risk of death and that the risk is highest among those with an amputation. However, it is important to remember that several studies have demonstrated that there is at least a twofold increase risk of death among those with diabetes and a foot ulcer as compared with those with diabetes and without a foot ulcer independent of limb ischemia (5–9). Whether treatment approaches change this risk of death is not well established and further study is needed. However, until we better understand how our interventions alter this risk, it is critical that we communicate to our patients who have diabetes and lower-limb disease that their foot disease is associated with increased risk of mortality.