Enhancing Diabetic Foot Care: Predicting Mortality Using ACG Risk Stratification in Clinical Practice
Applied/Translational Research
Singapore Health Biomedical Congress
National Healthcare Group
29 January 2026
Evaluated the association between ACG-defined risk categories and five-year mortality. Future research should focus on integrating digital foot-screening data into clinical decision-support systems to enable timely.
Year Submitted: 2025
Published Date: 29 January 2026
Tags: Applied/Translational Research, Quantitative Research
About this Content
Aims
Evaluated the association between ACG-defined risk categories and five-year mortality
Background
Diabetes mellitus remains a significant public health challenge in Singapore, with diabetic foot ulcers (DFUs) leading to severe complications, including amputations and increased mortality. The Agency for Care Effectiveness Clinical Guidance (ACG) recommends routine foot screening to stratify DFU risk and guide management. This study evaluated the association between ACG-defined risk categories and five-year mortality.
Methods
A retrospective cohort study of 1,413 patients with diabetes who underwent standardized foot assessments was conducted. Patients were classified into low-, moderate-, or high-risk categories based on ACG criteria, including neuropathy, peripheral arterial disease, deformity, or a history of amputation, ulceration, or callus. Multivariate Cox regression assessed the impact of demographic variables and ACG risk category on five-year all-cause mortality.
Results
Older age, male sex, and higher ACG risk categories were significantly associated with increased mortality. Compared to the low-risk group, moderate-risk patients had a hazard ratio (HR) of 2.10 (95%CI:1.50-2.94), while high-risk patients had a HR of 2.73 (95%CI:1.87-3.98). The estimated five-year mortality risk for a 65-year-old male was 18.8% (95%CI:14.2%-23.2%) in the moderate-risk group and 23.7% (95%CI:16.9%-30.0%) in the high-risk group.
Conclusion
Future research should focus on integrating digital foot-screening data into clinical decision-support systems to enable timely, individualized education and interventions within primary care.
Lessons Learnt
ACG foot risk stratification effectively predicts five-year mortality, offering clinicians a practical framework for enhancing diabetic footcare. Incorporating detailed assessment data - such as the Toe-Brachial Index - can further refine individual risk profiles. Translating categorical risk into personalized risk scores may improve patient understanding and motivation for preventive self-care.
Additional Information
SHBC Best Poster (Allied Health) - (Merit Award)
Keywords
Diabetes, Diabetic Foot, Diabetic Foot Screening, Foot Assessment, Mortality, Risk status, Risk Stratification
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | Tan Tock Seng Hospital |
Platform(s) | Singapore Health Biomedical Congress |
Healthcare Professional Group(s) | Allied Health, Medical |
Applicable Specialty or Discipline | Podiatry, Endocrinology, Surgery, Clinical Research |
Project Lead(s) | Chuan Guan Ng |
Project Member(s) | Cherry Cheong |
Connect with this contributor!
Chuan Guan Ng - chuan.guan.ng@nhghealth.com.sg