Aim: Diabetic foot ulcer (DFU) is a serious complication to diabetes. The aim was to study the incidence of first DFU among patients with type 1 (T1DM) and type 2 diabetes (T2DM), stratified according to etiology: neuropathic, neuro-ischemic or ischemic, over a period of 14 years (2001–2014).

Methods: DFU incidence rates were calculated from electronic patient record data from patients with T1DM and complicated T2DM from a large specialized diabetes hospital with a multidisciplinary foot clinic in Denmark. Poisson regression was used to model incidence of first DFU according to calendar year, diabetes type and etiology.

Results: Among 5640 patients with T1DM 255 developed a DFU, corresponding to an incidence of 5.8 (95% confidence interval (95%CI) 5.1–6.5) per 1000 patient years; this incidence dropped from 8.1 (95%CI 5.4–11.9) per 1000 patient years in 2002 to 2.6 (95%CI 1.3–5.3) in 2014 (p = 0.0059). Among 6953 patients with T2DM 310 developed a DFU, corresponding to an incidence of 11.3 (95%CI 10.1–12.6) per 1000 patient years; this incidence dropped from 17.0 (95%CI 12.2–23.8) per 1000 patient years in 2002 to 8.7 (95%CI 5.3–14.1) per 1000 patient year (p = 0.0260) in 2014.

Conclusion: The incidence of DFU has decreased substantially in T1DM as well as in T2DM. This change was driven by a decrease in incidence of neuropathic ulcers.