The burden of diabetic foot ulcers in a multi‐ethnic Asian cohort

AIMS: Diabetic foot ulcers (DFUs) are a major source of morbidity among individuals with diabetes mellitus (DM), imposing a substantial burden on healthcare systems. Our institution established a multidisciplinary service aiming to facilitate early specialist intervention for DFU management. This study examined demographic and cardiovascular risk profiles associated with DFU, the clinical burden of DFU in a large population, and the impact of our multidisciplinary specialist care on clinical outcomes. METHODS: We conducted a retrospective cohort study using the SingHealth Diabetes Registry on patients aged ≥18 years with DM from a tertiary centre between August 2018 and December 2023. There were 22,830 individuals with DM analysed; 2527 (11.1%) were diagnosed with DFU. Baseline demographics and clinical characteristics data were collected. Subgroup analyses were performed among patients attending the Diabetic Rapid Evaluation and lower limb Amputation Management (DREAM) clinic to evaluate differences in outcomes. RESULTS: Individuals with DFU were older, had a longer duration of DM, and had a significantly higher prevalence of cardiovascular and metabolic comorbidities compared with those without (p < 0.001). After multivariable adjustment, DFU was independently associated with increased mortality and prolonged hospitalization. Within the DFU cohort, referral to the multidisciplinary DREAM clinic in our institution was independently associated with a significantly reduced risk of major LEA, but not minor LEA, after multivariable adjustment. CONCLUSIONS: DFU represent a substantial clinical burden in Singapore and are independently associated with adverse outcomes. Beyond preventive screening, early multidisciplinary, multi-specialty management is critical to reduce amputations, hospitalization, and hence mortality.