The Epidemiology and Cost of Inpatient Care for Peripheral Vascular Disease, Infection, Neuropathy, and Ulceration in Diabetes

Currie, Craig John; Morgan, Christopher L.; Peters, John R.

doi:10.2337/diacare.21.1.42

Cited by 165 publications

(131 citation statements)

References 14 publications

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“…27 Individuals with diabetes undergo hospital admission due to PAD, associated infections, and skin ulceration, which are preventable complications of this disease. 28 A meta-analysis has demonstrated that a structured exercise program with duration greater than 30 minutes per session, three sessions per week was associated with a major improvement in maximal walking time for patients with PAD. 29 To date, there have been no randomized clinical trials that prospectively investigate the benefits of smoking cessation and weight loss in patients with PAD.…”

Section: Discussionmentioning

confidence: 99%

National health care costs of peripheral arterial disease in the Medicare population

et al. 2008

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Lower extremity peripheral arterial disease (PAD) is prevalent in the Medicare population and is associated with high rates of myocardial infarction, stroke, amputation, and death. Nevertheless, national health expenditures for PAD are not known. We hypothesized that PAD-related costs are high, increase with age, and that treatment rates would be less than known PAD prevalence. The objective was to determine national health care expenditures for PAD in the United States. PADrelated treatment costs were calculated in the elderly, non-disabled Medicare population. The cost analysis relied on the 5% control population for the linked SEERMedicare data and Medicare claims for the calendar year 2001, identifying PAD cases based on diagnosis and procedure codes. Costs were aggregated separately for inpatient and outpatient treatment and estimates adjusted to reflect the Medicare population. A total of $4.37 billion was spent on PAD-related treatment and 88% of expenditures were for inpatient care. Medicare program outlays totaled $3.87 billion, while enrollees (or their supplemental insurance) spent the remaining $500 million. In total, 6.8% of the elderly Medicare population received treatment for PAD. Treatment increased with age at rates of 4.5%, 7.5%, and 11.8% for individuals aged 65-74, 75-84, and >85 years, respectively. PAD-related costs accounted for approximately 13% of all Medicare Part A and B expenditures for the PAD-treated cohort, and 2.3% of total Medicare Part A and B expenditures. In conclusion, US national PAD-related costs are high, associated with inpatient care, and increase with age. PAD is treated at rates lower than the known PAD prevalence as only approximately one-third of the population with known PAD had detectable PAD-related health care costs in our analysis. The potential impact of earlier PAD detection and use of outpatient preventive strategies on total national PAD health care costs is unknown.

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Section: Discussionmentioning

confidence: 99%

National health care costs of peripheral arterial disease in the Medicare population

et al. 2008

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“…In a large study of unselected diabetic outpatients, skin infections (mainly fungal) were present in 20% of the sample and were the commonest dermatological complaint [55]. In another study analysing the epidemiology of inpatient care resulting from peripheral neuropathy, peripheral vascular disease and skin infections in a UK population of >400 000, diabetic patients had a 6-7 times greater risk of hospitalisation owing to skin and soft tissue infections and related conditions compared to agematched controls [56]. A recent Dutch primary care study that captured medically attended episodes of skin and mucous membrane infections showed odds ratios that were >30% greater for patients with either type 1 or 2 diabetes than for controls after adjustment for potential confounders [57].…”

Section: Skin Nail Mucous Membrane and Soft Tissue Infectionsmentioning

confidence: 99%

Common infections in diabetes: pathogenesis, management and relationship to glycaemic control

Peleg

Weerarathna

McCarthy

et al. 2006

Diabetes Metabolism Res

499

406

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SummarySpecific defects in innate and adaptive immune function have been identified in diabetic patients in a range of in vitro studies. However, the relevance of these findings to the integrated response to infection in vivo remains unclear, especially in patients with good glycaemic control. Vaccine efficacy seems adequate in most diabetic patients, but those with type 1 diabetes and high glycosylated haemoglobin levels are most likely to exhibit hyporesponsiveness. While particular infections are closely associated with diabetes, this is usually in the context of extreme metabolic disturbances such as ketoacidosis. The link between glycaemic control and the risk of common community-acquired infections is less well established but could be clarified if infection data from large community-based observational or intervention studies were available. The relationship between hospital-acquired infections and diabetes is well recognized, particularly among post-operative cardiac and critically ill surgical patients in whom intensive insulin therapy improves clinical outcome independent of glycaemia. Nevertheless, further research is needed to improve our understanding of the role of diabetes and glycaemic control in the pathogenesis and management of community-and hospitalacquired infections.

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“…Diabetic wounds repair very slowly, cause physical inability, and often require amputation. These problems are ultimately caused by poor metabolic control, over time leading to microvascular damage, nerve damage and reduced resistance to infection [1]. Up to the present, healing treatments of diabetic ulcers have not delivered satisfactory results.…”

Section: Introductionmentioning

confidence: 99%

Nerve growth factor promotes reparative angiogenesis and inhibits endothelial apoptosis in cutaneous wounds of Type 1 diabetic mice

et al. 2004

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Aims/hypothesis. The neurotrophin nerve growth factor (NGF) is pro-angiogenic and facilitates wound repair. The present study was conducted to (i) assess the statement of NGF system components in diabetic wounds and (ii) evaluate whether NGF supplementation could prevent impairment of wound neoangiogenesis by diabetes. Methods. Skin wounds were produced in the interscapular region of streptozotocin-induced diabetic mice. NGF (1 µg per day in PBS) or vehicle was applied onto the ulcers for 3 days after punching. Nondiabetic mice were used as controls.Results. In wounds of untreated diabetic mice, endogenous levels of immunoreactive NGF were lower than those in wounds of non-diabetic mice (p<0.01). Immunohistochemical analysis showed down-regulation of tyrosine kinase receptor-A (TrkA) and up-regulation of p75 receptor in granulation tissue microvasculature. Local NFG administration prevented diabetesinduced expressional alterations, enhanced reparative capillarisation (p<0.01), and accelerated wound closure (p<0.01). This was associated with a three-fold increase in endothelial cell proliferation (p<0.01), while apoptosis was reduced by 50% (p<0.05). Quantitative RT-PCR documented a 5.5-fold increase in the expression of vascular endothelial growth factor-A (VEGF-A) by exogenous NGF in diabetic tissues (p<0.01). In in vitro preparations of human endothelial cells from derma, NGF increased the release of immunoreactive VEGF-A, and reduced high-glucose-induced apoptosis (p<0.05), the latter effect being inhibited by a VEGF-A receptor-2 antagonist. Conclusions/interpretation. Diabetic ulcers display distinct alterations in reparative angiogenesis and in the expression of NGF and its receptors. NGF supplementation corrects endogenous liabilities, facilitates vascular regeneration, and suppresses endothelial apoptosis seemingly via VEGF-A. Our findings unravel new mechanisms responsible for NGF reparative action.

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The Epidemiology and Cost of Inpatient Care for Peripheral Vascular Disease, Infection, Neuropathy, and Ulceration in Diabetes

Cited by 165 publications

References 14 publications

National health care costs of peripheral arterial disease in the Medicare population

National health care costs of peripheral arterial disease in the Medicare population

Common infections in diabetes: pathogenesis, management and relationship to glycaemic control

Nerve growth factor promotes reparative angiogenesis and inhibits endothelial apoptosis in cutaneous wounds of Type 1 diabetic mice

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