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 one-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 timeframe. 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 one year, and 3.5% underwent a major-amputation. Of those amputated, 28.8% died within a year. Independent predictors of one-year mortality included male sex, older age, hospital-acquired DFU, insulin, major-amputation, cardiovascular disease, cancer, dementia, end-stage renal disease, and liver disease. Protective factors included lipid-lowering therapy, GLP-1 receptor agonists, and prior consultations with diabetologists, ophthalmologists, and podiatrists. Similar patterns were observed for post-amputation 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. GLP-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.