GLP-1 Receptor Agonists Are Associated With Reduced Mortality Following Diabetic Foot Ulcers: A Nationwide Observational Study

OBJECTIVE: This nationwide study aimed to identify factors associated with 1-year mortality following a first diabetic foot ulcer (DFU) using the French National Health Data System (SNDS). A secondary objective was to analyze mortality after major lower-limb amputation within the same time frame. RESEARCH DESIGN AND METHODS: A retrospective cohort analysis was conducted using SNDS data to identify adults with incident DFUs between January 2017 and December 2018, with 12 months of follow-up. Inclusion criteria combined hospitalization records and community care data. Cox proportional hazards models were used to estimate associations with mortality, adjusting for demographic, clinical, treatment, and care access variables. RESULTS: Among 133,791 individuals with incident DFU, 14.6% died within 1 year, and 3.5% underwent a major amputation. Of those amputated, 28.8% died within a year. Independent predictors of 1-year mortality included male sex, older age, hospital-acquired DFU, insulin, major amputation, cardiovascular disease, cancer, dementia, ESKD, and liver disease. Protective factors included lipid-lowering therapy, glucagon-like peptide 1 (GLP-1) receptor agonists, and prior consultations with diabetologists, ophthalmologists, and podiatrists. Similar patterns were observed for postamputation mortality, with GLP-1 receptor agonists showing a consistent survival benefit. CONCLUSIONS: One-year mortality after DFU remains high and is strongly linked to age and comorbidities. Community-based identification highlights the vulnerability of these patients, even outside hospital settings. Glucagon-like peptide 1 receptor agonists and structured, multidisciplinary follow-up are associated with better survival and should be prioritized. These findings underline the urgent need to reinforce preventive care and optimize care pathways for high-risk diabetic populations.