Health Care Service and Outcomes Among an Estimated 6.7 Million Ambulatory Care Diabetic Foot Cases in the U.S.

Skrepnek, Grant H.; Mills, Joseph L.; Lavery, Lawrence A.; Armstrong, David G.

doi:10.2337/dc16-2189

Cited by 123 publications

(104 citation statements)

References 37 publications

(44 reference statements)

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“…2 Furthermore, patients living with DFUs suffer great morbidity, lower health-related quality of life, and poorer psychosocial adjustment 3 and have a high burden of healthcare interactions. 4 Treatment of DFUs accounts for approximately one-third of the total cost of diabetic care, which was estimated to be U.S. $176 billion in direct healthcare expenditures in 2012. 5 Despite these high healthcare costs, about 20% of patients have unhealed DFUs at 1 year.…”

Section: Introductionmentioning

confidence: 99%

Update on management of diabetic foot ulcers

Everett

Mathioudakis

2018

Annals of the New York Academy of Sciences

583

403

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Diabetic foot ulcers (DFUs) are a serious complication of diabetes that results in significant morbidity and mortality. Mortality rates associated with the development of a DFU are estimated to be 5% in the first 12 months, and 5-year morality rates have been estimated at 42%. The standard practices in DFU management include surgical debridement, dressings to facilitate a moist wound environment and exudate control, wound off-loading, vascular assessment, and infection and glycemic control. These practices are best coordinated by a multidisciplinary diabetic foot wound clinic. Even with this comprehensive approach, there is still room for improvement in DFU outcomes. Several adjuvant therapies have been studied to reduce DFU healing times and amputation rates. We reviewed the rationale and guidelines for current standard of care practices and reviewed the evidence for the efficacy of adjuvant agents. The adjuvant therapies reviewed include the following categories: nonsurgical debridement agents, dressings and topical agents, oxygen therapies, negative pressure wound therapy, acellular bioproducts, human growth factors, energy-based therapies, and systemic therapies. Many of these agents have been found to be beneficial in improving wound healing rates, although a large proportion of the data are small, randomized controlled trials with high risks of bias.

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Section: Introductionmentioning

confidence: 99%

Update on management of diabetic foot ulcers

Everett

Mathioudakis

2018

Annals of the New York Academy of Sciences

583

403

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“…Two of the most common diabetic neuropathic foot impairments seen either in community clinics or diabetic foot specialty clinics are Charcot neuroarthropathy (CNA) and neuropathic plantar ulcers (NPU). [1, 2]. Both NPU and acute CNA occur in the presence of sensory and autonomic peripheral neuropathy [3,4].…”

Section: Introductionmentioning

confidence: 99%

Immobilization-induced osteolysis and recovery in neuropathic foot impairments

Sinacore

Hastings

Bohnert

et al. 2017

Bone

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Background Neuropathic foot impairments treated with immobilization and off-loading result in osteolysis. In order to prescribe and optimize rehabilitation programs after immobilization we need to understand the magnitude of pedal osteolysis after immobilization and the time course for recovery. Objective To determine differences in a) foot skin temperature; b) calcaneal bone mineral density (BMD) after immobilization; c) calcaneal BMD after 33–53 weeks of recovery; and d) percent of feet classified as osteopenic or osteoporotic after recovery in participants with neuropathic plantar ulcers (NPU) compared to Charcot neuroarthropathy (CNA). Methods Fifty-five participants with peripheral neuropathy were studied. Twenty-eight participants had NPU and 27 participants had CNA. Bilateral foot skin temperature was assessed before immobilization and bilateral calcaneal BMD was assessed before immobilization, after immobilization and after recovery using quantitative ultrasonometry. Results Before immobilization, skin temperature differences in CNA between their index and contralateral foot were markedly higher than NPU feet (3.0 degree C versus 0.7 degree C, respectively, p < .01); BMD in NPU immobilized feet averaged 486 ± 136 mg/cm2, and CNA immobilized feet averaged 456 ± 138 mg/cm2, p >0.05). After immobilization, index NPU feet lost 27 mg/cm2; CNA feet lost 47 mg/cm2 of BMD, p < 0.05. After recovery, 61% of NPU index feet and 84% of CNA index feet were classified as osteopenic or osteoporotic. Conclusions There was a greater osteolysis after immobilization with an attenuated recovery in CNA feet compared to NPU feet. The attenuated recovery of pedal BMD in CNA feet resulted in a greater percentage of feet classified as osteoporotic and osteopenic.

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“…Whilst there is a possibility that our estimated DRLEC disability burden may contain a small proportion attributable to upper extremity diabetic peripheral neuropathy, we note we were unable to include additional DRLECs, such as diabetes-related 'peripheral vascular disease', in our YLD estimates for DRLECs as they were not disaggregated in the GBD2015 publication [1]. With DRLECs also resulting in mortality rates worse than those attributable to many cancers [2,4,5], we recommend future GBD publications should present YLD, years of life lost and disability-adjusted life-year estimates for 'lower-extremity complications due to diabetes' to highlight to policymakers the potentially significant overall global burden of DRLECs, as they do for 'chronic kidney disease due to diabetes' [1]. With DRLECs also resulting in mortality rates worse than those attributable to many cancers [2,4,5], we recommend future GBD publications should present YLD, years of life lost and disability-adjusted life-year estimates for 'lower-extremity complications due to diabetes' to highlight to policymakers the potentially significant overall global burden of DRLECs, as they do for 'chronic kidney disease due to diabetes' [1].…”

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confidence: 99%

Diabetes‐related lower‐extremity complications are a leading cause of the global burden of disability

et al. 2018

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Globally ~435 million people have diabetes [1], and an estimated 19-34% (~83-148 million people) of those will be expected to develop foot ulcers in their lifetime [2]. Foot ulcers are typically precipitated by other diabetes-related lower-extremity complications, (DRLECs) including peripheral neuropathy and peripheral vascular disease [2,3]. Collectively, DRLECs are a leading cause of infection, hospitalization and amputation outcomes [2-5], yet, these outcomes are readily preventable with evidence-based care [6,7]. This suggests the burden caused by DRLECs is a large, yet reducible, cause of the global burden of disease. This article is protected by copyright. All rights reserved.

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Health Care Service and Outcomes Among an Estimated 6.7 Million Ambulatory Care Diabetic Foot Cases in the U.S.

Abstract: This investigation of an estimated 6.7 million diabetic foot cases indicates markedly greater risks for both ED/IP admissions and number of outpatient visits, with DFUs also associated with a higher odds of referrals to other physicians and longer physician visit times.

Cited by 123 publications

References 37 publications

Update on management of diabetic foot ulcers

Update on management of diabetic foot ulcers

Immobilization-induced osteolysis and recovery in neuropathic foot impairments

Diabetes‐related lower‐extremity complications are a leading cause of the global burden of disability

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