Diabetic patients who develop foot ulcers are more likely to die prematurely than those who do not, a study has suggested.
They are also more likely to die from heart attacks and strokes, researchers have found.
While cardiovascular disease is associated with the condition, researchers wanted to examine whether those with diabetic foot ulceration (DFU) were at an increased risk.
They looked at data from eight studies concerning 17,830 diabetic patients. Of those, 3,619 died during the follow-up.
They found that 34% of DFU patients died during the follow-up compared to 17% of diabetic patients who did not develop the complication.
The DFU patients also had an increased risk of fatal heart attacks and strokes, according to the paper published in Diabetologia.
Diabetes can damage a person's blood vessels and nerves, and poor circulation and nerve damage in the feet make people vulnerable to unnoticed cuts or other injuries which could develop into ulcers, or sores.
In severe cases, this can lead to foot or leg amputation.
Researchers said that healthcare professionals needed to improve detection rates and management of foot ulcers.
Robert Hinchliffe from St George's, University of London, who co-led the study, said: "Our research, which is the largest and therefore most reliable study to date, shows that people withdiabetes who have foot ulcers are at considerably higher risk of an earlier death compared to those patients without.
"We suspect that this may be due in part to the effect of infections among those with foot ulcers and the greater co-existence of cardiovascular disease and foot ulcers with diabetesalthough the reasons are not entirely clear."
Professor Kausik Ray, who also co-led the study, added: "Our results warrant further investigation as to whether even greater control of risk factors such as blood pressure, blood glucose and early preventative screening can further reduce mortality among those with foot ulcers.
"There is likely an unmet potential to reduce deaths in this group."
Charity Diabetes UK recently said that specialist diabetes foot care teams needed to be in place in every hospital.
A spokesman said people with diabetes who had foot ulcers should be referred to a multi-disciplinary footcare team within 24 hours.
There are 3.7 million diabetes sufferers in the UK, but the charity estimates that 850,000 people have the disease but do not know it.
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