Treating Diabetic Foot Ulcers Like An Aggressive Cancer

When we tackle the problem of diabetic foot ulcers, the idea is not just the mortality. The idea is that diabetes is like cancer but we do not tend to treat diabetes like cancer and we should be. We should be communicating and using the same language in terms of morbidity and mortality as we do with cancer. When we look at the data from a new study, the mortality rate is similar to the rate of very aggressive cancer.¹

In this study, researchers assessed 20,737 people who developed diabetic foot ulcers.¹ The authors note that 5 percent of people with new ulcers died within 12 months of their first physician visit for a foot ulcer and 42.2 percent of people with foot ulcers died within five years. Researchers note a diabetic foot ulcer should be a major warning sign for mortality, necessitating closer medical follow-up.

What I think we have to do when a person develops a diabetic foot ulcer is to immediately get all hands on deck and start aggressive risk factor modification. I am just talking about metabolic issues. Diabetes is not just metabolic. Diabetes is a cardiovascular disease. These patients have to have aggressive treatment not just metabolically but just as importantly, if not more importantly, for risk factor modification and treatment of their hypertension, cholesterol and lipids.

When people with diabetic foot ulcers heal, just like with cancer, they are not really healed. Our patients are in remission. We tend to think about wounds when they are open but why don’t we think about them when they are closed?

It is these ulcer-free days that we should be aiming for. We should be aiming for having people at home in diabetic foot remission monitoring themselves. We should be helping them monitor themselves. We should be getting them in outpatient facilities relatively frequently but trying to expand the time they have that soft tissue envelope intact and are able to walk through and navigate their world. This is our definition of success in this population.

It is an almost certainty that these wounds are going to recur. What we have to do is make those recurrences as minor and as infrequent as possible and allow these people to navigate their world as best as they possibly can.

Reference

1. Walsh JW, Hoffstad OJ, Sullivan MO, Margolis DJ. Association of diabetic foot ulcer and death in a population-based cohort from the United Kingdom. Diabetic Med. 2015; epub Dec. 15.