Lead author Marjolein M. Iversen, from Bergen University College, Norway, states, "The results underline the importance of organizing future health care services with follow-up routines that allow for early and tight clinical monitoring in persons with a history of foot ulcer in primary care."

"Previous prospective studies of mortality in people with diabetic foot ulcers," she added, "have been conducted in cohorts from various hospital settings. However, a substantial proportion of people with foot ulcers are treated in primary care. Our study is the first large population-based study conducted on foot ulcers among individuals with diabetes."

The new findings are based on data from 1,339 diabetic patients with a history of foot ulcers, 155 diabetic non-foot-ulcer subjects, and 63,632 non-diabetic participants in the Nord-Trondelag Health Study in Norway. Subjects were followed for 10 years for mortality.

The mortality rate for diabetics with a history of foot ulcers was 49.0%, much higher than the 35.2% and 10.5% rates seen in the diabetics without a foot ulcer history and the non-diabetics, respectively.

After adjusting for demographic and lifestyle factors, diabetics with a history of foot ulcers were 2.29 times more likely to die during follow-up than were non-diabetic subjects. Among diabetic subjects, foot ulcer history was associated with a 38% increased risk of death.

The association between foot ulcer history and mortality did not change substantially after accounting for cardiovascular disease, microalbuminuria, or Hospital Anxiety and Depression Scale depression scores, the researchers found.

"Future studies need to address the effects of interventions to improve the quality of care and enhance collaboration between specialist and primary health services," Iversen noted. "I'm currently involved in setting up such a study."