According to the American Diabetes Association (ADA), 60% to 70% of diabetes patients develop peripheral nerve damage. Fifteen percent to 20% of diabetes patients have been hospitalized for foot complications. Charcot foot, which develops in 0.5% of these patients, tends to occur after age 50 years and in diabetes of many years’ duration (15 to 20 years).
Although there has been an increase in the number of adults with diabetes who have seen a health professional for diabetes and had their feet checked for sores or irritations, the CDC has set a targeted 10% increase (to 74.8%) for 2020. Between 2004 and 2008, variations in rates of annual foot examination were observed with age progression. Although there was a 4.5% decrease in annual foot examinations among diabetes patients aged 18 to 44 years, rates increased among patients aged 45 to 64 (4.3%), 65 to 74 (7.1%), and ≥75 years (10.8%).
The ADA has reported that 15% of patients with diabetes will develop a foot ulcer at some point. The annual incidence of foot ulcers in diabetes patients is 1% to 4%, and the rate of prevalence is 4% to 10%. Men are at increased risk for foot ulcers or amputations. The ADA estimates that 14% to 25% of patients with foot ulcers will require amputation.
Of all patients who underwent
nontraumatic amputation of the lower leg, 70% had diabetes. About 65,700 lower-limb amputations were performed in diabetes patients in 2007. In that same year, the number of lower-limb amputations was twice as high among African American patients than among white patients (4.9 vs. 2.4 per 1,000 population). Between 2003 and 2007, the number of lower-extremity amputations among diabetes patients decreased five times more in white patients than in African American patients (by 35.1% vs. 7.5%). Males outnumbered females in amputations performed (4.8 vs. 2.2 per 1,000 population); however, there was a 31% decrease in females versus a 25% decrease in males. The number of amputations was nearly identical among patients aged 65 to 74 years and those aged >75 years (4.5 vs. 4.6 per 1,000 population). However, for every 1,000 population, patients aged <65 years had about 27% fewer amputations than older patients. The decrease in amputations was highest among patients aged >75 years (by 47%), followed by those aged 65 to 74 years (38%); the decrease was least among those aged <65 years (23%). Literature bears evidence that a 45% to 85% reduction in amputations is possible if a comprehensive foot-care program is employed.
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