Long-Term Mortality in Diabetic Foot Disease is Higher Than That of Overall Cancer: Results From Three International Cohorts.

BACKGROUND: Guidelines suggest that the risk of mortality in diabetic foot disease (DFD) is comparable to that of cancer; however, high-quality evidence is lacking. We aimed to compare the mortality of DFD with that of various cancers based on data from international cohorts. METHODS: We defined DFD according to the IWGDF 2023 guidelines, and cancer was defined based on the ICD-10 codes. We included 527, 1784, and 601 patients with DFD and 1219, 100,643, and 152 patients with cancer from the National Health and Nutrition Examination Survey (NHANES), UK Biobank (UKB), and Chongqing Diabetes Registration (CDR) cohorts, respectively. We compared the risk of mortality between DFD and overall or site-specific cancers in the same cohort. RESULTS: Patients with DFD showed 38%, 45%, and 499% higher risks of mortality than patients with overall cancer in the NHANES, UKB, and CDR. For site-specific cancer, the risk of mortality was significantly higher in DFD than in skin cancer (hazard ratio 10.69, 95% CI: 1.37-2.07 in NHANSE; 3.8, 3.72-448 in UKB), breast cancer (1.35, 1.0-1.83 in NHANSE; 1.95, 1.67-227 in UKB), and prostate cancer (1.4, 1.8-179 in NHANSE; 2.61, 2.35-289 in UKB). The mortality rate of DFD is similar to that of most types of cancer, such as colon cancer, lymphoma, and kidney cancer, and is lower than that of a minority of cancers, including lung, pancreatic, and liver cancers. CONCLUSION: Patients with DFD have a higher risk of mortality than overall cancer, particularly skin, breast, and prostate cancers.