A new declaration for feet's sake: Halving the global diabetic foot disease burden from 2% to 1% with next generation care

Abstract

The 1989 Saint Vincent Declaration established a goal of halving global diabetes‐related amputation rates. A generation later, this goal has been achieved for major but not minor amputations. However, diabetic foot disease (DFD) is not only a leading cause of global amputation but also of hospitalisation, poor quality of life (QoL) and disability burdens. In this paper, we review latest estimates on the global disease burden of DFD and the next generation care of DFD that could reduce this burden. We found DFD causes 2% of the global disease burden. This makes DFD the 13th largest of 350+ leading conditions causing the global disease burden, and much larger than dementia, breast cancer and type 1 diabetes. Neuropathy without ulcers and amputations makes up the largest portion of the global DFD burden yet receives the least DFD focus. Future care focussed on improving safe physical activity in people with DFD could considerably reduce the DFD burden, as this incorporates increasing physical fitness and QoL, while simultaneously decreasing ulceration and other risks. Charcot neuro‐osteoarthropathy is more prevalent than previously thought. Most cases respond well to non‐removable offloading devices, but surgical intervention may further reduce the considerable burden of these neuropathic fracture dislocations. Ischaemia is becoming more common and complex. Most cases respond well to revascularisation interventions, but novel revascularisation techniques, medical management and autologous cell therapies may hold the key to more cases responding in the future. We conclude that DFD causes a global disease burden larger than most conditions and existing guideline‐based care and next generation treatments can reduce this burden. We suggest the World Health Organization and International Diabetes Federation declare a new goal: halving the global DFD burden from 2% to 1% within the next generation.

The Stress of Measuring Plantar Tissue Stress in People with Diabetes-Related Foot Ulcers: Biomechanical and Feasibility Findings from Two Prospective Cohort Studies

“…Diabetes is the most rapidly growing cause of the global disease burden [ 1 ], affecting an estimated 537 million people worldwide [ 2 , 3 ]. Diabetes-related foot ulcers are the leading cause of the global diabetes-related hospitalisations, amputations, and disease burden, affecting an estimated 20 million people yearly, with at least another 130 million people at risk [ 4 , 5 ]. These ulcers substantially reduce quality of life and impose a large disease burden on patients and society [ 5 , 6 , 7 , 8 ].…”

“…Diabetes-related foot ulcers are the leading cause of the global diabetes-related hospitalisations, amputations, and disease burden, affecting an estimated 20 million people yearly, with at least another 130 million people at risk [ 4 , 5 ]. These ulcers substantially reduce quality of life and impose a large disease burden on patients and society [ 5 , 6 , 7 , 8 ]. Unfortunately, not all factors in the ulcer healing process are completely understood.…”

Early Treatment of Acute Stage 0/1 Diabetic Charcot Foot Can Avoid Major Amputations at One Year

“…CNO has historically been considered a rare complication of diabetes, but recent studies suggest that the prevalence of CNO is substantially underestimated [ 4 ]. A novel analysis by Lazzarini et al underlined that 58% of the total global disease burden caused by Diabetic Foot Disease is the disability burden: this burden for the most part is at the expense of people with neuropathy without ulcers (thus including CNO) [ 5 ]. A nationwide cohort study conducted in Sweden showed the increasing prevalence of diabetic CNO from 0.55 to 0.79% (from 1.06 to 1.97% for type 1 diabetes) during the period 2006–2016 [ 6 ].…”

The unique multidisciplinarity of diabetes‐related foot disease

“…1 In addition to these 21 publications that describe the presentday knowledge in diabetes-related foot disease, we also present 6 reviews from experts in the field in this special virtual issue. [23][24][25][26][27][28] These reviews aim to help guide the field forward, and discuss topics where the evidence may be thin, and where research and clinical practice can together advance the field and drive innovations.…”

“…As a result of the ever-growing burden of both diabetes and diabetes-related foot disease, 25,29 continued efforts to improve remain needed. The unique multidisciplinarity of medical professionals involved in diabetes-related foot disease as shown in the list of 25 professions provided above requires huge collaborative efforts.…”