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Diabetic Foot Complications

Somnath Pal, BS (Pharm), MBA, PhD
Professor of Pharmacy Administration

College of Pharmacy & Health Sciences, St. John’s University

Jamaica, New York


6/19/2014

US Pharm. 2014 ;39(6):56.

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).


Foot Examination: 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%).

Foot Ulcers: 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.

Lower-Limb Amputations: 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.

To comment on this article, contact rdavidson@uspharmacist.com.

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