Morbidity and Mortality Rates in People with Diabetes Mellitus With an Active Charcot's Neuro-Osteoarthropathy: A 15-Year Single-Center Retrospective Analysis

Diabetes related Charcot neuro-osteoarthropathy (CN) of the foot is associated with increased risks of amputation and premature mortality. We aimed to report the amputation and mortality rates of people with active CN and identify participant and CN characteristics associated with these adverse outcomes. A single-center retrospective study. Participants were included if they were diagnosed with an active CN with type 1 or type 2 diabetes mellitus presenting to a specialist foot clinic between January 2007 and September 2022. Participant and CN characteristics were analyzed to determine relationships with amputation or mortality. 186 participants were included with 195 CN feet. Median follow-up was 8.2 years (IQR 5.3, 12.2). Male sex (p = 0.026) and previous amputation (p = 0.003) were associated with a significantly increased risk of amputation. The 1-year, 5-year, and 10-year mortality rates were 2.7% (5/186), 18.9% (23/122), and 40% (24/60), respectively. Previous amputation and worsening chronic kidney disease stage were associated with a significantly increased mortality risk (p = 0.005 and p = 0.027, respectively). Participants with CN had high amputation and mortality rates. The causes of death were multifactorial, suggesting clinicians should focus on early aggressive multiple risk factor intervention to reduce these adverse outcomes. Diabetes related nerve disease can lead to foot problems. One of these is where the joints of the foot become disrupted and the bones no longer align correctly – this is called a Charcot foot. It occurs in about 1 in 200 people with diabetes. Having a Charcot foot is recognized as a predictor of ulceration and amputation and also premature death. In this study, we looked at the data from 186 people with a new onset Charcot followed up at 1 hospital specialist diabetes foot clinic over 15 years, and looked at what factors determined the increased risk of having an amputation or early death. We found that being male and having a previous amputation were the strongest predictors of having an amputation, and having a previous amputation and long-term kidney disease were the factors most predictive of an early death. We recommend that people with a Charcot have their cardiovascular risk factors optimized as soon as possible to help prevent amputations and early death.