Mindset linked to poor foot ulcer outcome

The mindset of people with diabetic foot ulcers about their illness has a significant effect on their survival, new research has suggested.

The five year study looked at the heath outcome of 169 people with diabetes and foot ulcers.

Researchers from the University of Nottingham wanted to expand on previous research which has linked depression to poorer clinical outcomes for ulcer patients.

Professor Kavita Vedhara from the University of Nottingham’s School of Medicine, said: “We wanted to test the hypothesis that life expectancy in people with diabetic foot ulcers is shorter in patients with negative beliefs regarding their ulcers.”

Predicted survival

The participant’s diabetes type, glucose control, number of previous ulcers, size and location of ulcer and infection levels were collected at baseline.

They were then completed a survey of their illness beliefs and depression levels.

We found that of the 160 patients for whom data on mortality were available, 104 were alive and 56 had died

They were all given the same foot care advice and treatment for their foot ulcers.

Further data about survival and mortality were collected on the patients in 2011, between four and nine years after they had been recruited into the study.

Professor Vedhara said: “We found that of the 160 patients for whom data on mortality were available, 104 were alive and 56 had died. The patients had an average age of 61 and most had type 2 diabetes.

“Most patients had had a previous ulcer and in one third of the cohort the index ulcer was infected at the start of the study. The psychological data revealed on average low levels of depression.

“Our analysis examined whether patients’ beliefs about their ulcer predicted survival, after taking into account the effects of depression and other clinical factors that might be expected to influence mortality.

“We found that, although depression was not a significant predictor, patients who believed their ulcers were associated with greater symptoms died more quickly.

“These patients also believed that their ulcers would have more serious consequences for them, believed they would last a long time, found them distressing and believed they had little control over them. This constellation of beliefs appears to have been common in people who died more quickly in this study.”

The findings of the study, published in the scientific and medical journal PLOS ONE, could improve understanding of mortality risk and could also inform future therapeutic treatment to improve survival.