Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar 24;13(1):16.
doi: 10.1186/s13047-020-00383-2.

Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer

David G Armstrong  1 , Mark A Swerdlow  2 , Alexandria A Armstrong  2 , Michael S Conte  2 , William V Padula  2 , Sicco A Bus  2
Affiliations

Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer

David G Armstrong et al. J Foot Ankle Res. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Five Year Mortality of Diabetic Foot Complications and Cancer. Diabetic foot complications compared to cancer. DFU = diabetic foot ulcers [11] = 30.5%. Charcot = Charcot neuroarthropathy of the foot [14]. All Cancer = pooled 5 year survival of all cancers [11]. CLTI = chronic limb threatening ischemia [28, 29]. Major Amputation = above foot amputation [–22, 26, 27]. Minor Amputation = foot level amputation [17, 27]
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367–2375. - PubMed
    1. Infection guideline - IWGDF Guidelines. IWGDF Guidelines. https://iwgdfguidelines.org/infection-guideline/. Published May 25, 2019. Accessed December 22, 2019.
    1. Prompers L, Huijberts M, Apelqvist J, et al. High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia. 2007;50:18–25. - PubMed
    1. IDF Diabetes Atlas 9th edition 2019. https://diabetesatlas.org/en/. Accessed December 6, 2019. - PubMed
    1. Wukich DK, Raspovic KM, Suder NC. Patients with diabetic foot disease fear major lower-extremity amputation more than death. Foot Ankle Spec. 2018;11(1):17–21. - PubMed

MeSH terms