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Management of diabetic foot complications


Epidemiology

Epidemiology and healthcare cost of diabetic foot problems

This chapter highlights the various factors associated with risk of lower extremity morbidity, and briefly discusses the cost effectiveness of prevention of such.

Summary
  • Lower extremity morbidity is a major contributor to the burden of diabetes on individuals and on healthcare systems.
  • The reported prevalence of diabetic peripheral neuropathy (DPN) ranges from 16% to 66%. Manifestations of DPN include autonomic neuropathy (often overlooked), reduced motor function, and sensory neuropathy (the most commonly recognized).
  • Peripheral vascular disease results in the inability of the dysvascular or ischemic limb to properly heal. Additionally, musculoskeletal deformity, which includes a hammertoe or bunion, and can arise due to motor neuropathy, predisposes to increased pressure and friction.
  • In addition to these factors, there are several modifiable risk factors associated with lower extremity disease, such as glycemic control (better control may be associated with reduced risk of lower extremity amputation).
  • A ‘perfect storm’ of risk factors for ulceration has been proposed by some researchers; one group found that the presence of at least two risk factors increased risk of ulceration between 35% and 78%, with a clinical triad of neuropathy, minor foot trauma and foot deformity present in more than 63% of those developing an ulcer.
  • Risk for amputation has been found to be greater among men than women in numerous studies, and studies have also identified racial and ethnic disparities in incidence of diabetic amputation. Lower socioeconomic status has been shown to carry a higher likelihood of amputation.
  • While a direct causal relationship has not been shown between amputation and mortality, a strong association has been demonstrated in several studies. Perioperative mortality following amputation ranges from 5.8% to 23% during the first 30 days.
  • It is generally agreed that prevention of lower extremity ulceration, infection and amputation is the most desirable approach, and is highly cost effective or cost saving.

Cook JJ, Simonson DC. In: The diabetic foot: Medical and surgical management. Edited by Veves A, Giurini JM, LoGerfo FW. Humana Press, 2012. doi: 10.1007/978-1-61779-791-0_2

Contents

​​​​​​​Back to collection

  1. Epidemiology
  2. Clinical features and diagnosis
  3. Management​​​​​​​
  4. Organization and preventative care