Pulse pressure and prediction of incident foot ulcers in type 2 diabetes.

OBJECTIVE: To assess the relevance of pulse pressure as a predictor of foot ulcers in type 2 diabetic subjects. RESEARCH DESIGN AND METHODS: A cohort study was performed on a consecutive series of 1,945 type 2 diabetic outpatients without a foot ulcer at baseline. Incident foot ulcers were identified through the regional hospital discharge system, which contains ICD codes of current diagnoses. RESULTS: During a follow-up of mean +/- SD 4.2 +/- 2.2 years, 86 ulcers were observed. After adjusting for confounders, the highest quartiles of pulse pressure had a 2.39-fold (95% CI 1.14-5.02) risk of foot ulcers. When ischemic ulcers were considered separately, the highest pulse pressure quartile was associated with an increased age- and sex-adjusted risk (2.08 [95% CI 1.02-4.24]), whereas no increase of risk was observed for neuropathic ulcers. CONCLUSIONS: Elevated pulse pressure represents an independent predictor of foot ulcers in diabetic patients; this parameter should be considered for the stratification of risk of ischemic or neuroischemic ulcers.