Advanced

The impact of metabolic control and QTc prolongation on all-cause mortality in patients with type 2 diabetes and foot ulcers.

Fagher, Katarina LU and Löndahl, Magnus LU (2013) In Diabetologia 56(5). p.1140-1147
Abstract
AIMS/HYPOTHESIS: The increased all-cause mortality in patients with chronic diabetic foot ulcers cannot fully be explained by traditional cardiovascular risk factors. The significance of heart-rate-corrected QT (QTc) prolongation, a finding often seen in these patients, is unknown. Recently, the importance of metabolic control and hypoglycaemia has been discussed. The aim of this study was to evaluate the impact of different HbA(1c) levels and QTc prolongation on all-cause mortality in the high-risk population of patients with type 2 diabetes mellitus and foot ulcers. METHODS: All patients with type 2 diabetes, younger than 80 years, visiting our diabetes foot unit, with a foot ulcer duration >4 weeks, were screened for participation.... (More)
AIMS/HYPOTHESIS: The increased all-cause mortality in patients with chronic diabetic foot ulcers cannot fully be explained by traditional cardiovascular risk factors. The significance of heart-rate-corrected QT (QTc) prolongation, a finding often seen in these patients, is unknown. Recently, the importance of metabolic control and hypoglycaemia has been discussed. The aim of this study was to evaluate the impact of different HbA(1c) levels and QTc prolongation on all-cause mortality in the high-risk population of patients with type 2 diabetes mellitus and foot ulcers. METHODS: All patients with type 2 diabetes, younger than 80 years, visiting our diabetes foot unit, with a foot ulcer duration >4 weeks, were screened for participation. Patients on dialysis were excluded. Patients were grouped according to HbA(1c) level and QTc time ≤ or > 440 ms. RESULTS: Patients (n = 214, median age 69.1 years) were grouped according to HbA(1c) level (HbA(1c) < 7.5% [<58 mmol/mol] n = 81, 7.5-8.9% [58-74 mmol/mol] n = 70, >8.9% [>74 mmol/mol] n = 63). Baseline characteristics, including use of potential hypoglycaemic drugs, were similar between groups. During the 8 years of follow-up 151 patients died (70.6%) and HbA(1c) < 7.5% (<58 mmol/mol) was strongly associated with increased mortality. The highest mortality was seen in patients with a combination of HbA(1c) < 7.5% (<58 mmol/mol) and QTc prolongation, with an 8 year mortality of 92.1% as compared with 48.8% in those with HbA(1c) < 7.5% (<58 mmol/mol) but without QTc prolongation. CONCLUSION/INTERPRETATIONS: HbA(1c) < 7.5% (<58 mmol/mol) in a high-risk population of patients with type 2 diabetes and foot ulcers is associated with a significantly higher mortality, particularly in patients with QTc prolongation. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Diabetologia
volume
56
issue
5
pages
1140 - 1147
publisher
Springer
external identifiers
  • wos:000318787100021
  • pmid:23404446
  • scopus:84876485667
ISSN
1432-0428
DOI
10.1007/s00125-013-2860-x
language
English
LU publication?
yes
id
1c35aa2b-8e1a-4b19-b2df-c9422a46c808 (old id 3559857)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/23404446?dopt=Abstract
date added to LUP
2016-04-01 11:13:33
date last changed
2020-01-12 07:49:38
@article{1c35aa2b-8e1a-4b19-b2df-c9422a46c808,
  abstract     = {AIMS/HYPOTHESIS: The increased all-cause mortality in patients with chronic diabetic foot ulcers cannot fully be explained by traditional cardiovascular risk factors. The significance of heart-rate-corrected QT (QTc) prolongation, a finding often seen in these patients, is unknown. Recently, the importance of metabolic control and hypoglycaemia has been discussed. The aim of this study was to evaluate the impact of different HbA(1c) levels and QTc prolongation on all-cause mortality in the high-risk population of patients with type 2 diabetes mellitus and foot ulcers. METHODS: All patients with type 2 diabetes, younger than 80 years, visiting our diabetes foot unit, with a foot ulcer duration &gt;4 weeks, were screened for participation. Patients on dialysis were excluded. Patients were grouped according to HbA(1c) level and QTc time ≤ or &gt; 440 ms. RESULTS: Patients (n = 214, median age 69.1 years) were grouped according to HbA(1c) level (HbA(1c) &lt; 7.5% [&lt;58 mmol/mol] n = 81, 7.5-8.9% [58-74 mmol/mol] n = 70, &gt;8.9% [&gt;74 mmol/mol] n = 63). Baseline characteristics, including use of potential hypoglycaemic drugs, were similar between groups. During the 8 years of follow-up 151 patients died (70.6%) and HbA(1c) &lt; 7.5% (&lt;58 mmol/mol) was strongly associated with increased mortality. The highest mortality was seen in patients with a combination of HbA(1c) &lt; 7.5% (&lt;58 mmol/mol) and QTc prolongation, with an 8 year mortality of 92.1% as compared with 48.8% in those with HbA(1c) &lt; 7.5% (&lt;58 mmol/mol) but without QTc prolongation. CONCLUSION/INTERPRETATIONS: HbA(1c) &lt; 7.5% (&lt;58 mmol/mol) in a high-risk population of patients with type 2 diabetes and foot ulcers is associated with a significantly higher mortality, particularly in patients with QTc prolongation.},
  author       = {Fagher, Katarina and Löndahl, Magnus},
  issn         = {1432-0428},
  language     = {eng},
  number       = {5},
  pages        = {1140--1147},
  publisher    = {Springer},
  series       = {Diabetologia},
  title        = {The impact of metabolic control and QTc prolongation on all-cause mortality in patients with type 2 diabetes and foot ulcers.},
  url          = {http://dx.doi.org/10.1007/s00125-013-2860-x},
  doi          = {10.1007/s00125-013-2860-x},
  volume       = {56},
  year         = {2013},
}