The treatment of diabetic foot ulcers (DFU) is intricate, not only because of the multiple scopes of wounds such as infection, circulation, poor healing to deal with but also the higher coexisting comorbidities of patients.
Using nationwide study, we evaluation the incidence of severe DFUs, the characteristics of patients, the presentations of wounds, as well as the treatment and lower-extremity amputations (LEA) outcomes. In Taiwan, DFU continues to remain a major medical and public health issue as we face patients in increased numbers, age, and comorbidities. The annual incidence of LEA decreases over years whereas the proportion of people receiving peripheral artery intervention increased. Moreover, promising trends of reducing gangrene on presentation paired with increased in vascular interventions support contoured vigilance and rapid, coordinated interdisciplinary team of diabetic foot care across hospitals, hospital networks, and national health services.
Two subgroups of patients with DFU were further studied. The annual prevalence of subjects with end-stage renal disease (ESRD) has increased some 3.9-fold over 14 years. More significantly, these ESRD patients now account for approximately 30% of annual major-LEA of the total DFU population. Peripheral arterial disease was the major difference of foot presentation compared to those of without ESRD. The increase of endovascular treatments was associated with a reduction in rate of limb loss. People with diabetes and ESRD should be educated to prevent foot ulcers and the interdisciplinary team approach is indicated if DFU complicated.
Another subgroup is patients with the first diagnosis of DFU. The mean 5-year survival rate of these subjects was 81.05%, which is much better than reports on DFU population, suggesting earlier identification of this population could lead to higher survival rate. Cardiovascular comorbidity and LEA status were major factors associated with patient survival outcomes.

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