The 10-year follow-up of a community-based cohort of people with diabetes: the incidence of foot ulceration and death

Mohammed Shijat, Fay Crawford*, Genevieve Isabelle Cezard, Michail Papathomas

*Corresponding author for this work

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Background: Identifying people with diabetes who are likely to experience a foot ulcer is an important part of preventative care. Many cohort studies report predictive models for foot ulcerations and for people with diabetes, but reports of long-term outcomes are scarce.
Aim: We aimed to develop a predictive model for foot ulceration in diabetes using a range of potential risk factors with a follow-up of 10 years after recruitment. A new foot ulceration was the outcome of interest and death was the secondary outcome of interest.
Design: A 10-year follow-up cohort study.
Methods: 1193 people with a diagnosis of diabetes who took part in a study in 2006–2007 were invited to participate in a 10-year follow-up. We developed a prognostic model for the incidence of incident foot ulcerations using a survival analysis, Cox proportional hazards model. We also utilised survival analysis Kaplan–Meier curves, and relevant tests, to assess the association between the predictor variables for foot ulceration and death.
Results: At 10-year follow-up, 41% of the original study population had died and more than 18% had developed a foot ulcer. The predictive factors for foot ulceration were an inability to feel a 10 g monofilament or vibration from a tuning fork, previous foot ulceration and duration of diabetes. 
Conclusions: The prognostic model shows an increased risk of ulceration for those with previous history of foot ulcerations, insensitivity to a 10 g monofilament, a tuning fork and duration of diabetes. The incidence of foot ulceration at 10-year follow-up was 18%; however, the risk of death for this community-based population was far greater than the risk of foot ulceration.
Original languageEnglish
Article numbere459
Number of pages13
JournalEndocrinology, Diabetes & Metabolism
VolumeEarly View
Early online date21 Nov 2023
Publication statusE-pub ahead of print - 21 Nov 2023


  • Cohort study
  • Diabetes mellitus
  • Foot ulcer
  • Prediction


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