Introduction: Foot infections are a common complication of type 2 diabetes. However, the clinical sequelae of diabetic foot infection (DFI) in the general population remain poorly characterized.

Methods: We conducted a prospective cohort analysis of 1,451 participants with diabetes (mean age, 63 years [SD: 5.6]; 33% black; 47% female) in the ARIC study (visit 4: 1996-1998) . DFI was ascertained using ICD-9/codes from Medicare claims and hospital discharge records. We used Kaplan-Meier analyses to estimate the 5-year cumulative incidence of nontraumatic lower-extremity amputation (NLEA) , major fall, cardiovascular disease (CVD) [coronary heart disease, stroke, or heart failure], and death following incident DFI. We evaluated the association between incident DFI (modeled as a time-varying exposure) and the subsequent risk of clinical outcomes with Cox models.

Results: During over two decades of follow-up (1996-1998 to 2017) , there were 328 incident DFIs, 72 NLEAs, 502 major falls, 748 CVD events, and 915 deaths. Following incident DFI, the five-year cumulative incidence of major clinical outcomes ranged from 14.7% (NLEA) to 38.6% (death) (Fig 1a) . Incident DFI was significantly associated with all clinical outcomes after multivariable adjustment (Fig 1b) .

Conclusion: DFI is a high-risk marker for major morbidity and mortality in the general population of adults with diabetes.


M.Fang: n/a. J.Hu: None. K.Matsushita: Consultant; Akebia Therapeutics, Inc., Mitsubishi Tanabe Pharma Corporation, Other Relationship; Fukuda Denshi, Research Support; Kyowa Kirin Co., Ltd. E.Selvin: Other Relationship; Wolters Kluwer. C.W.Hicks: None.


HHS (N268201700001I) , HHS (N268201700002I) , HHS (N268201700003I) , HHS (N268201700005I) , HHS (N268201700004I) , NHLBI (K24HL152440)

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at