Frailty, diabetic foot ulceration and mortality in people diagnosed with type 2 diabetes: Multistate analysis of primary care patients in the UK clinical practice research datalink.

AIMS: Diabetic foot ulceration (DFU) is a serious complication of diabetes. Frailty is common in individuals with type 2 diabetes and has been associated with a higher mortality risk. We investigated the risk of DFU and mortality in relation to frailty in individuals with type 2 diabetes.

METHODS

We identified DFU and mortality events between 2000 and 2021 in the Clinical Practice Research Datalink GOLD primary care records linked to hospital and mortality data. Frailty was categorised using the electronic frailty index. We employed parametric multistate modelling to describe the transitions across the states 'Type 2 diabetes', 'DFU' and 'Mortality'.

RESULTS

In 186,473 individuals with type 2 diabetes (median age, 62 years; 50.9 % women), 3,551 (1.9 %) developed DFU and 53,118 (28.5 %) died during a median follow-up of 8.8 years. Greater frailty was associated with higher rates of DFU and, especially, mortality. In women diagnosed at 60, the 10-year adjusted probability of DFU was 2.1 %, 1.9 %, 2.9 %, and 3.2 % for fit, mild, moderate, and severe frailty, respectively; corresponding estimates in men were 2.6 %, 2.7 %, 3.7 %, and 4.4 %.

CONCLUSIONS

Information on age and frailty at type 2 diabetes diagnosis is necessary to enhance risk stratification and guide personalised diagnostic and therapeutic strategies for DFU.