Depression predicts first but not recurrent diabetic foot ulcers

• Published in: Diabetologia Vol. 53; no. 10; pp. 2241 - 2248
• Main Authors: Gonzalez, J. S, Vileikyte, L, Ulbrecht, J. S, Rubin, R. R, Garrow, A. P, Delgado, C, Cavanagh, P. R, Boulton, A. J. M, Peyrot, M
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Berlin/Heidelberg : Springer-Verlag 01-10-2010; Springer-Verlag; Springer; Springer Nature B.V
• Subjects: Activities of daily living; Adult and adolescent clinical studies; Aged; Associated diseases and complications; Biological and medical sciences; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction; Depression; Depression - complications; Depressive symptoms; Diabetes; Diabetes. Impaired glucose tolerance; Diabetic Foot - complications; Diabetic peripheral neuropathy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Foot diseases; Foot self-care; Foot ulcers; Human Physiology; Humans; Internal Medicine; Leg ulcers; Longitudinal; Male; Medical sciences; Medicine; Medicine & Public Health; Mental depression; Metabolic Diseases; Middle Aged; Mood disorders; Nervous system (semeiology, syndromes); Neurology; Peripheral neuropathy; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Recurrence; Regression Analysis; Risk factors; Self Care; Severity of Illness Index; United Kingdom > UK; United States > US; Baltimore Maryland; Longitudinal; Diabetic peripheral neuropathy; Foot self-care; Foot ulcers; Depression; Depressive symptoms; Diabetes; Endocrinopathy; Mood disorder; Skin disease; Nervous system diseases; Diabetic Foot; Diabetes mellitus; Care; Disease of the foot; Ulcer; Peripheral nerve disease
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-010-1821-x

Aims/hypothesis This study examined the relationship between symptoms of depression and the development of diabetic foot ulcers. Methods Participants were 333 patients (71% male; mean age 62 years; 73% with type 2 diabetes) with diabetic peripheral neuropathy (DPN), but without peripheral vascular disease (PVD). Severity of DPN and the presence of PVD were assessed by clinical examination. Depression, other diabetes complications and foot self-care were assessed by self-report. Cox regression tested whether depression was an independent predictor of foot ulceration over 18 months, whether this relationship was moderated by foot ulcer history, and whether foot self-care mediated this relationship. Results During follow-up, 63 patients developed a foot ulcer. Those with prior foot ulcers had more than four-fold greater risk of subsequent foot ulceration compared with those without a history of foot ulcer. A significant interaction effect showed that depression was significantly related to the development of first but not recurrent foot ulcers. This relationship was independent of biological risk factors. In the final model, each standard deviation increase in depression symptoms was significantly associated with increased risk of developing first foot ulcers (HR 1.68, 95% CI 1.20-2.35), while foot self-care was associated with lower risk (HR 0.61, 95% CI 0.40-0.94). Foot self-care did not mediate the relationship between depression and foot ulceration. Conclusions/interpretation These data suggest that depression is associated with increased risk of first foot ulcers in DPN patients and that this relationship is independent of biological risk factors and foot self-care. Interventions that target depression and foot self-care before the development of foot ulcers may maximise the likelihood of successful prevention of foot ulceration.