Diabetic Foot: Evaluation and Management
Diabetic Foot: Evaluation and Management
Approximately 15% of persons with diabetes will have an ulcer in their lifetime, and 0.5% to 29.0% will have neuropathic joint changes. Diabetes is the leading cause of nontraumatic amputations, amounting to 57,000 per year or 150 per day. One half to 80% of all amputations are diabetes-related. It is postulated that 50% of these can be prevented through a comprehensive lower extremity amputation (LEA) prevention program, which is part of the goals for Healthy People 2010 ( Table 2 ).
The cost of foot disease is astounding. Medicare records show that $1.5 billion was spent directly on diabetic foot ulcers from 1995 to 1996. Almost three fourths of this was spent during inpatient treatment alone. Today, the annual cost of diabetic foot ulcer care is $5 billion in direct cost and $400 million in indirect cost. Unfortunately, 70% of people with ulcers have little or no regular follow-up care, which is necessary to prevent progression. In a study of inpatient ulcer care, only 1.6% had prescriptions for off-loading materials at discharge, and only 11.0% had arrangements for home health wound care.
The sequelae of ulceration, including amputation, cost of prosthesis, and rehabilitation after amputation is enormous. The direct cost of LEA ranges from $20,000 to $60,000 per patient. In 1992, the cost of rehabilitation was $14,500 to $21,500 per patient. This does not include the cost of prosthesis.
Approximately 15% of persons with diabetes will have an ulcer in their lifetime, and 0.5% to 29.0% will have neuropathic joint changes. Diabetes is the leading cause of nontraumatic amputations, amounting to 57,000 per year or 150 per day. One half to 80% of all amputations are diabetes-related. It is postulated that 50% of these can be prevented through a comprehensive lower extremity amputation (LEA) prevention program, which is part of the goals for Healthy People 2010 ( Table 2 ).
The cost of foot disease is astounding. Medicare records show that $1.5 billion was spent directly on diabetic foot ulcers from 1995 to 1996. Almost three fourths of this was spent during inpatient treatment alone. Today, the annual cost of diabetic foot ulcer care is $5 billion in direct cost and $400 million in indirect cost. Unfortunately, 70% of people with ulcers have little or no regular follow-up care, which is necessary to prevent progression. In a study of inpatient ulcer care, only 1.6% had prescriptions for off-loading materials at discharge, and only 11.0% had arrangements for home health wound care.
The sequelae of ulceration, including amputation, cost of prosthesis, and rehabilitation after amputation is enormous. The direct cost of LEA ranges from $20,000 to $60,000 per patient. In 1992, the cost of rehabilitation was $14,500 to $21,500 per patient. This does not include the cost of prosthesis.
