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Diabetes sufferers who also develop foot ulcers appear more likely to die prematurely, a new study warns. Investigators believe the findings highlight a potential need for improved detection and management of those with both issues.

The researchers say the results underline the importance of a two-pronged approach for people with diabetes: enhanced foot ulceration screening as early detection and treatment may help reduce some of the complications; and more intensive control of blood pressure and cholesterol among those diagnosed with foot ulcers since they are at higher cardiovascular risk.

In a study of 17,830 patients with diabetes — 3,095 diagnosed with foot ulceration and 14,735 without — researchers from St. George’s, University of London investigated how diabetic foot ulcers affected a person’s risk of dying earlier. There were an extra 58 deaths per 1,000 people each year with diabetic foot ulcers.

Investigators analyzed patient records from eight studies, conducted in Europe, America, Australasia and South-East Asia, published between 2006 and 2011. The length of time participants were followed varied between an average of two and 10 years for each study.