Diabetic Retinopathy Relates to the Incidence of Foot Ulcers and Amputations in Type 2 Diabetes

We investigated whether Diabetic Retinopathy (DR) is related to Diabetic Foot Ulcers (DFU) development, adjusted for the stratification of the International Work Group on Diabetic Foot (IWGDF) guidance. DR and IWGDF stratification were registered retrospectively in patients hospitalized from 2009 to 2017 for uncontrolled and/or complicated type 2 diabetes. New DFUs were registered until 2020. Survival analyses categorized the subjects for DR, and multivariate Cox regression adjusted for confounders. The 522 patients (57.9% male) were 62±9 years old, with a diabetes duration of 14±10 years, HbA1c of 8.7±1.8%, 33.9% macroangiopathies and 44.8% diabetic kidney diseases. Their grades of DFU risk were 0 for 43.3%, 1 for 23.9%, 2 for 7.1%, and 3 for 25.6%. During the 52 months follow-up (IQR: 32-71), 58 new DFUs and 18 lower-limb amputations occurred, mostly in patients with DR present in 140 (26.8%) patients. Adjusted for age, sex and conventional risk factors (duration and control of diabetes, arterial hypertension, dyslipidemia), and other complications (macroangiopathy, diabetic kidney disease), DR associated with a greater incidence of DFUs. Adjusted for the IWGDF classification, DR was related to new DFUs (HR: 2.51, 95%CI: 1.48-4.26) and amputations (HR: 3.56, 95%CI: 1.26-10.07). This relationship persisted in ascending IWGDF grades, with incidences of DFUs from 2/1000 (grade 0, no DR) to 121/1000 patient-years (grade 3 and DR), and amputations from 0 (grade 0, no DR) to 38/1000 patient-years (grade 3 and DR). Diabetic retinopathy independently relates to the incidence of foot ulcers and amputations in patients hospitalized for type 2 diabetes. This article is protected by copyright. All rights reserved.