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Frailty Is Associated with Impaired Diabetic Foot Ulcer Healing and All-Cause Re-Hospitalization

Research output: Contribution to journalArticlepeer-review

Giuseppe Maltese, G. Basile, H. Meehan, M. Fuller, M. Cesari, N. Fountoulakis, J. Karalliedde

Original languageEnglish
Pages (from-to)169-173
Number of pages5
JournalJournal of Nutrition, Health and Aging
Issue number2
Early online date22 Jan 2022
E-pub ahead of print22 Jan 2022
PublishedFeb 2022

Bibliographical note

Funding Information: We acknowledge the assistance of the podiatry team at Guy?s and St Thomas Hospital. Publisher Copyright: © 2022, The Author(s).

King's Authors


Background: Diabetic Foot Ulcers (DFUs) are a common and feared complication of type 1 and type 2 diabetes. People with DFUs often present a significant clinical complexity due to multimorbidity, frailty, polypharmacy, and disabling conditions. Frailty, defined using the accumulation of health deficits model, has shown to predict worsening health status, hospitalizations, and death in older persons. There are no clinical studies, to date, that have examined the prevalence and effect of frailty on DFUs outcomes. The aim of our study was to explore the impact of frailty on DFUs healing and re-hospitalization in a cohort of patients hospitalized with DFUs. Design: prospective cohort study. Setting and Participants: The frailty status of 76 consecutive hospitalized patients with DFUs was assessed by using the Frailty Index (FI). Measurements: The primary outcome was the non-healing of the DFU. Secondary outcome was re-hospitalization events (for any cause) within 6 months from hospital discharge. Frailty was defined as FI>0.25. Results: Out of 76 patients (median age 65 years, range 31–84), 56 (74%) were frail. At six months, 81.5% of frail patients had nonhealing of the DFU compared to 55% in non-frail patients (p=0.02). The rate of of re-hospitalization was also higher in frail compared to non-frail (90.3% vs 54%, respectively; p=0.01) patients. In multivariable analyses, frailty was significantly associated with a more than fivefold increased risk of DFU non-healing [odds ratio 5.54 (95% confidence interval 1.28–23.91), p=0.02]. Similarly, re-hospitalization was also significantly higher in frail patients compared to the non-frail ones. Conclusions: In hospitalized patients with DFUs, frailty was highly prevalent. Frailty emerged as an independent risk factor for DFU non-healing and re-hospitalization events. Patients with DFUs require a comprehensive assessment of their frailty status which would enable personalization of their management and interventions.

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