The presence of foot ulcers in patients with diabetes more than doubles the risk of premature death compared with those without ulceration, an updated meta-analysis has found.

The finding highlights the importance of managing nephropathy and coronary artery disease, both of which increase the likelihood of microvascular complications, the UK researchers say.

In a systematic review and meta-analysis of 11 studies, data from nearly 450,000 participants with either type 1 or type 2 diabetes, 25,000 of whom had foot ulcers, was used to investigate the association between foot ulcers and the risk of death.

On average, patients who developed foot ulcers were older than those without ulcers (age 68 versus 65), had a longer duration of diabetes (12 versus seven years), and a higher prevalence of cerebrovascular disease, hypertension, coronary artery disease and nephropathy.