Impact of diabetic foot ulcers on mortality risk: Lessons from a 35-year Brazilian cohort followed at an association of people living with diabetes.

OBJECTIVE: To evaluate the impact of diabetic foot ulcers (DFUs) on mortality risk in a Brazilian cohort of individuals followed at an association of people living with diabetes mellitus. SUBJECTS AND METHODS: This retrospective, population-based epidemiological study assessed the impact of DFUs on mortality risk in a cohort of Brazilian individuals with types 1 and 2 diabetes mellitus. Data were obtained from medical records covering the period from 1990 to 2024 and included sociodemographic, clinical, laboratory, and therapeutic variables. Survival analyses were conducted using Cox proportional hazards models, with death as the event of interest, and were adjusted for potential confounders. RESULTS: Among the 382 participants included in the final analysis, DFUs, amputations, and diabetic peripheral neuropathy were associated with increased mortality risk by 89%, 123%, and 37%, respectively. Peripheral artery disease showed a modest, but not statistically significant, increase in mortality risk. Patients with DFUs who were not using oral antidiabetic drugs had a 165% higher mortality risk, and those with prior amputations and poor fasting glucose levels had a 41% increased mortality risk. CONCLUSION: Overall, DFUs were identified as critical predictors of mortality in people living with diabetes mellitus, mostly among those with type 2 diabetes mellitus. The impact of DFUs on mortality risk is multifaceted and context-dependent, highlighting the leading role of prior amputations. These findings underscore the need for targeted early interventions and the implementation of strategies aimed at reducing mortality in this high-risk population.