Diabetic foot ulcers, amputations, and diabetic peripheral neuropathy were associated with increased mortality risk by 89%, 123%, and 37%, respectively, identifying DFUs as 'critical predictors of mortality in people living with diabetes mellitus, mostly among those with type 2 diabetes mellitus.'
Key Findings
Results
Diabetic foot ulcers (DFUs) were associated with an 89% increased mortality risk in a Brazilian cohort of individuals with diabetes mellitus.
Study was a retrospective, population-based epidemiological cohort study with 382 participants in the final analysis.
Data were obtained from medical records covering a 35-year period from 1990 to 2024.
Survival analyses were conducted using Cox proportional hazards models with death as the event of interest, adjusted for potential confounders.
Both type 1 and type 2 diabetes mellitus patients were included in the cohort.
DFUs were identified as 'critical predictors of mortality in people living with diabetes mellitus, mostly among those with type 2 diabetes mellitus.'
Results
Amputations were associated with a 123% increased mortality risk in the cohort.
Among the 382 participants, prior amputations showed the highest mortality risk increase of any single factor examined.
The impact of DFUs on mortality risk was described as highlighting 'the leading role of prior amputations.'
Cox proportional hazards models were used to assess this association, adjusted for potential confounders.
Patients with prior amputations and poor fasting glucose levels had a 41% increased mortality risk.
Results
Diabetic peripheral neuropathy was associated with a 37% increased mortality risk.
Diabetic peripheral neuropathy was one of three foot-related complications found to be statistically significantly associated with increased mortality.
This association was identified alongside DFUs and amputations as part of a Cox proportional hazards model analysis.
The study cohort included 382 participants with types 1 and 2 diabetes mellitus followed over 35 years.
Results
Peripheral artery disease showed a modest but not statistically significant increase in mortality risk.
Unlike DFUs, amputations, and diabetic peripheral neuropathy, peripheral artery disease did not reach statistical significance as a mortality predictor in this cohort.
The finding was noted as a 'modest, but not statistically significant, increase in mortality risk.'
This was assessed within the same Cox proportional hazards survival analysis framework used for other variables.
Results
Patients with DFUs who were not using oral antidiabetic drugs had a 165% higher mortality risk.
This subgroup analysis identified non-use of oral antidiabetic drugs as a significant modifier of mortality risk among DFU patients.
The 165% increased mortality risk was the highest risk increase reported for any subgroup in the study.
This finding underscores the context-dependent nature of DFU-associated mortality risk.
The analysis was part of adjusted Cox proportional hazards models examining therapeutic variables.
Conclusions
The impact of DFUs on mortality risk was described as multifaceted and context-dependent, with the study underscoring the need for targeted early interventions.
The study was conducted at an association of people living with diabetes mellitus in Brazil, following participants from 1990 to 2024.
Sociodemographic, clinical, laboratory, and therapeutic variables were all included in the analysis.
The authors concluded that 'findings underscore the need for targeted early interventions and the implementation of strategies aimed at reducing mortality in this high-risk population.'
The study population included both type 1 and type 2 diabetes mellitus patients, with DFU impact noted as most pronounced in type 2.
What This Means
This research followed 382 people living with diabetes in Brazil over 35 years (1990–2024) to understand how diabetic foot ulcers (DFUs) and related complications affect the risk of dying. Using statistical survival analysis, the researchers found that having a diabetic foot ulcer nearly doubled the risk of death (89% increase), while having had an amputation more than doubled it (123% increase). Nerve damage in the feet (diabetic peripheral neuropathy) was also linked to a 37% higher risk of death. Notably, patients with foot ulcers who were not taking oral diabetes medications had the highest risk of all — a 165% increase in mortality risk compared to those without ulcers.
The findings highlight that diabetic foot complications are not just a problem for quality of life — they are serious predictors of early death, particularly in people with type 2 diabetes. The study also found that poor blood sugar control (reflected in fasting glucose levels) combined with a history of amputation further raised the risk of dying. Peripheral artery disease was associated with higher mortality as well, but this association did not reach statistical significance in this cohort.
This research suggests that early and aggressive management of diabetic foot ulcers — including blood sugar control, use of appropriate medications, and prevention of amputations — could play a meaningful role in extending the lives of people with diabetes. The results call attention to the importance of structured foot care programs and regular monitoring for high-risk patients, particularly in healthcare settings serving people with longstanding diabetes.
Negrato C, Pedrosa H, Chaparim L, Catelli M, Lopes L. (2026). Impact of diabetic foot ulcers on mortality risk: Lessons from a 35-year Brazilian cohort followed at an association of people living with diabetes.. Archives of endocrinology and metabolism. https://doi.org/10.20945/2359-4292-2026-0121