A diabetic foot ulcer (DFU) is associated with increased cardiovascular risk and mortality independently of ulcer etiology (ischemic, neuro-ischemic or neuropathic). Traditional cardiovascular risk factors can partly, but not alone explain this risk increment. Ankle-brachial index (ABI) is the most commonly used test when diagnosing peripheral vascular disease and is also considered a marker for increased cardiovascular risk. However, ABI do not reflect microvascular dysfunction, a condition often seen in DFU patients. Transcutaneous oxygen pressure (TcPO2) is considered to better evaluate microvascular function and has in previous studies shown correlations with both wound healing and survival. The aim of this study was to evaluate the combined impact of a low TcPO2 (< 30 mmHg) and a pathological ABI (< 0.8 or ≥1.4) on 3-year mortality rates in patients with DFU. We evaluated 202 type 2 diabetic patients with DFU, aged 18-85 years. As shown in the Figure, individuals with a combination of pathological ABI and low TcPO2 had the worst survival rates, with 3-year mortality of 54%, compared to 42% in those with pathological ABI alone and 21% in those with normal ABI/TcPO2. Age did not differ between groups (median 75, 75, 74 years respectively).
In conclusion, combining ABI and TCPO2 in routine assessment could provide additional predictive information when risk stratifying patients with type 2 diabetes and DFU.
K. Fagher: Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. M. Londahl: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi.
Swedish Diabetes Foundation; Skåne County Councils Research and Development Foundation; Lund University