• 1

    Ramsey SD, Newton K, Blough D, et al: Incidence, outcomes, and cost of foot ulcers in patients with diabetes. .Diabetes Care 22::382. ,1999. .

  • 2

    Pecoraro R, Reiber G, Burgess E: Pathways to diabetic limb amputation: basis for prevention. .Diabetes Care 13::513. ,1990. .

  • 3

    Apelqvist J, Larsson J, Agardh C: Long-term prognosis for diabetic patients with foot ulcers. .J Intern Med 233::485. ,1993. .

  • 4

    Price P: Defining and measuring quality of life. .J Wound Care 5::139. ,1996. .

  • 5

    Aalto AM, Uutela A, Kangas T: Health, behavior, social integration, perceived health and dysfunction: a comparison between patients with type I and II diabetes and controls. .Scand J Prim Health Care 15::97. ,1996. .

    • Search Google Scholar
    • Export Citation
  • 6

    Brod M: Quality of life issues in patients with diabetes and lower extremity ulcers: patients and care givers. .Qual Life Res 7::365. ,1998. .

  • 7

    Hjelm K, Nyberg P, Apelqvist J: Gender influences beliefs about health and illness in diabetic subjects with severe foot lesions. .J Adv Nurs 40::673. ,2002. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Kinmond K, McGhee P, Gough S, et al: Loss of self: a psychosocial study of the quality of life of adults with diabetic foot ulceration. .J Tissue Viability 13::6. ,2003. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Goodridge D, Trepman E, Embil JM: Health-related quality of life in diabetic patients with foot ulcers. .J Wound Ostomy Continence Nurs 32::368. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Vileikyte L: Diabetic foot ulcers: a quality of life issue. .Diabetes Metab Res Rev 17::246. ,2001. .

  • 11

    Croxson S: Diabetes in the elderly: problems of care and service provision. .Diabet Med 19::S66. ,2002. .

  • 12

    Douglas V: Living with a chronic leg ulcer: an insight into patients’ experiences and feelings. .J Wound Care 10::355. ,2001. .

  • 13

    Fox RD: Innocent beginnings, uncertain futures: exploring the challenges of living with diabetic foot ulcers. .Can J Diabetes 29::105. ,2005. .

    • Search Google Scholar
    • Export Citation
  • 14

    Meijer JWG, Trip J, Jaegers SM, et al: Quality of life in patients with diabetic foot ulcers. .Disabil Rehabil 23::336. ,2001. .

  • 15

    Ribu L, Hanestad BR, Moum T, et al: A comparison of the health-related quality of life in patients with diabetic foot ulcers, with a diabetes group and a non-diabetes group from the general population. .Qual Life Res 16::179. ,2007. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Eckman MH, Greenfield S, Mackey WC, et al: Foot infections in diabetic patients: decision and cost-effectiveness analyses. .JAMA 273::712. ,1995. .

  • 17

    Tenvall GR, Apelqvist J: Health-related quality of life in patients with diabetes mellitus and foot ulcers. .J Diabetes Complications 14::235. ,2000. .

  • 18

    Peters EJG, Childs MR, Wunderlich RP, et al: Functional status of persons with diabetes-related lower-extremity amputations. .Diabetes Care 24::1799. ,2001. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Carrington AL, Mawdsley SKV, Morley M, et al: Psychological status of diabetic people with or without lower limb disability. .Diabetes Res Clin Pract 32::19. ,1996. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Nabuurs-Franssen MH, Huijberts MSP, Nieuwenhuijzen Kruseman AC, et al: Health-related quality of life of diabetic foot ulcer patients and their caregivers. .Diabetologia 48::1906. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Ismail K, Winkley K, Stahl D, et al: A cohort study of people with diabetes and their first foot ulcer: the role of depression on mortality. .Diabetes Care 30::1473. ,2007. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Jacobson AM, de Groot M, Samson JA: The effects of psychiatric disorders and symptoms on quality of life in patients with type I and type II diabetes mellitus. .Qual Life Res 6::11. ,1997. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    World Health Organization: Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications: Report of a WHO Consultation, World Health Organization, Geneva. ,1999. .

  • 24

    Office of National Statistics: ONS Standard Occupational Classification 2000: Volume 1: Structure and Description of Unit Groups; Volume 2: The Coding Index, Stationery Office, London. ,2000. .

  • 25

    Saunders J, Aasland O, Babor TF, et al: Development of the Alcohol Use Disorders Identifications Test (AUDIT): WHO collaborative project on the early detection of persons with harmful alcohol consumption. .Addiction 88::791. ,1993. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Jeffcoate S: Diabetes control and complications: the role of glycated haemoglobin, 25 years on. .Diabet Med 21::657. ,2004. .

  • 27

    Rajbhandari S, Harris N, Sutton M, et al: Digital imaging: an accurate and easy method of measuring foot ulcers. .Diabet Med 16::339. ,1999. .

  • 28

    Armstrong DG, Lavery LA, Harkless LB: Validation of a diabetic wound classification system. .Diabetes Care 21::855. ,1998. .

  • 29

    Anderson RJ, Freedland KE, Clouse RE, et al: The prevalence of co-morbid depression in adults with diabetes. .Diabetes Care 6::1069. ,2001. .

    • Search Google Scholar
    • Export Citation
  • 30

    World Health Organization: SCAN: Schedules for Clinical Assessment in Neuropsychiatry, Version 2.1, World Health Organization, Geneva. ,1997. .

  • 31

    Ware JE Jr, Sherbourne CD: The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. .Med Care 30::473. ,1992. .

  • 32

    Stewart AL, Hays RD, Ware JE: The MOS short-form general health survey: reliability and validity in a patient population. .Med Care 26::724. ,1988. .

  • 33

    Ware JE, Kosinski M, Keller SD: SF-36 Physical and Mental Health Summary Scores: A User’s Manual and Interpretation Guide, The Health Institute, New England Medical Center, Boston. ,1994. .

  • 34

    Sullivan M, Karlsson J, Ware JE: The Swedish SF-36 health survey: I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. .Soc Sci Med 41::1349. ,1195. .

    • Search Google Scholar
    • Export Citation
  • 35

    Ware JE, Snow KK, Kosinski B: SF-36 Health Survey: Manual and Interpretation Guide, The Health Institute, New England Medical Center, Boston. ,1993. .

  • 36

    Vileikyte L, Peyrot M, Bundy CE, et al: The development and validation of a neuropathy- and foot ulcer-specific quality of life instrument. .Diabetes Care 26::2549. ,2003. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Ware JE, Kosinski M, Bjorner JB, et al: User’s Manual for the SF-36v2 Health Survey, 2nd Ed, QualityMetric Inc, Lincoln, RI. ,2007. .

  • 38

    McHorney CA, Ware JE, Raczek AE: The MOS 36-item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. .Med Care 31::247. ,1993. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Sinacore D: Total contact casting for diabetic neuropathic ulcers. .Phys Ther 76::296. ,1996. .

  • 40

    Jacobson AM, de Groot M, Samson JA: The evaluation of 2 measures of quality of life in patients with type 1 and type 2 diabetes. .Diabetes Care 17::267. ,1994. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Trief PM, Wade MJ, Pine D: A comparison of health-related quality of life in elderly and younger insulin-treated adults with diabetes. .Age Ageing 32::613. ,2003. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42

    Abetz L, Sutton M, Brady L, et al: The Diabetic Foot Ulcer Scale (DFS): a quality of life instrument for use in clinical trials. .Practical Diabetes Int 19::167. ,2002. .

    • Search Google Scholar
    • Export Citation
  • 43

    Yamada T, Ohta T, Ishibashi H, et al: Clinical reliability and utility of skin perfusion pressure measurement in ischemic limbs: comparison with other noninvasive diagnostic methods. .J Vasc Surg 47::318. ,2008. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44

    Armstrong DG, Lavery LA, Wrobel JS, et al: Quality of life in healing diabetic wounds: does the end justify the means?. J Foot Ankle Surg 47::278. ,2008. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45

    Goodridge D, Trepman E, Sloan J, et al: Quality of life in adults with unhealed and healed diabetic foot ulcers. .Foot Ankle Int 27::274. ,2006. .

  • 46

    Idler EL, Angel RJ: Self-related health and mortality in the NHANES-I epidemiologic follow-up study. .Am J Public Health 80::446. ,1990. .

  • 47

    Bradley C, Todd C, Gorton T, et al: The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life: the AFFQoL. .Qual Life Res 8::79. ,1999. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48

    UK Prospective Diabetes Study Group: Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37). .Diabetes Care 22::1125. ,1999. .

    • PubMed
    • Search Google Scholar
    • Export Citation

Quality of Life in People with Their First Diabetic Foot Ulcer

A Prospective Cohort Study

Kirsty Winkley Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, England.

Search for other papers by Kirsty Winkley in
Current site
Google Scholar
PubMed
Close
 PhD
,
Daniel Stahl Department of Biostatistics, Institute of Psychiatry, King’s College London, London, England.

Search for other papers by Daniel Stahl in
Current site
Google Scholar
PubMed
Close
 PhD
,
Trudie Chalder Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, England.

Search for other papers by Trudie Chalder in
Current site
Google Scholar
PubMed
Close
 PhD
,
Michael E. Edmonds Diabetic Foot Clinic, King’s College Hospital, London, England.

Search for other papers by Michael E. Edmonds in
Current site
Google Scholar
PubMed
Close
 FRCP
, and
Khalida Ismail Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, England.

Search for other papers by Khalida Ismail in
Current site
Google Scholar
PubMed
Close
 PhD
Restricted access

Background: People with diabetic foot ulcers report poor quality of life. However, prospective studies that chart quality of life from the onset of diabetic foot ulcers are lacking. We describe change in quality of life in a cohort of people with diabetes and their first foot ulcer during 18 months and its association with adverse outcomes.

Methods: In this prospective cohort study of adults with their first diabetic foot ulcer, the main outcome was change in Medical Outcomes Study 36-Item Short Form Health Survey scores between baseline and 18-month follow-up. We recorded baseline demographics, diabetes characteristics, depression, and diabetic foot outcomes and mortality at 18 months.

Results: In 253 people with diabetes and their first ulcer, there were 40 deaths (15.8%), 36 amputations (15.5%), 99 recurrences (43.2%), and 52 nonhealing ulcers (21.9%). The 36-Item Short Form Health Survey response rate of survivors at 18 months was 78% (n = 157). There was a 5- to 6-point deterioration in mental component summary scores in people who did not heal (adjusted mean difference, −6.54; 95% confidence interval, −12.64 to −0.44) or had recurrent ulcers (adjusted mean difference, −5.30; 95% confidence interval, −9.87 to −0.73) and a nonsignificant reduction in those amputated (adjusted mean difference, −5.00; 95% confidence interval, −11.15 to 1.14).

Conclusions: Quality of life deteriorates in people with diabetes whose first foot ulcer recurs or does not heal within 18 months. (J Am Podiatr Med Assoc 99(5): 406–414, 2009)

Corresponding author: Kirsty Winkley, PhD, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, Weston Education Centre, 10 Cutcombe Rd, London SE5 9RJ, England. (E-mail: kirsty.winkley@iop.kcl.ac.uk)