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Growing Clinical Challenge

Diabetes affects millions of people in the United States.1 Both the prevalence of the disease and the number of complications arising from it are increasing. Diabetic foot ulcers (DFUs) are a common complication and are associated with significant morbidity and mortality, which result in considerable treatment challenges for healthcare providers.

The diabetes epidemic in America
Diagnosed with Diabetes
  • 26 million people in the US had diabetes in 20103
  • 7 million of these people were undiagnosed3
  • 15% of those with diabetes can expect to develop a foot ulcer at some point in their lives4,5
  • Obesity puts people at greater risk; over 85% of people with type 2 diabetes are overweight6

DFUs and their complications
Lower-limb amputations due to DFUs
Cost of DFUs and lower-limb amputations
Fight to reduce amputations
DFU patient education

DFUs and their complications

  • In patients with diabetes, high blood sugar levels, in patients with diabetes, can damage nerves or blood vessels, which may cause loss of feeling in the feet. Patients may not feel a cut, blister, or ulcer
  • Damage to the blood vessels can also mean that a patient’s feet do not get enough blood and oxygen, which makes it harder for the foot to heal if a sore or infection develops
  • Foot injuries can cause ulcers and infections1
  • Serious DFUs may even lead to amputation1

Complications of the diabetic foot are common, complex, and costly. Approximately 15% of those with diabetes can expect to develop a foot ulcer at some point in their lives.4,5

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Lower-limb amputations due to DFUs

  • Amputations among patients with diabetes are prevalent and are a great cost to the healthcare system
  • More than 60% of nontraumatic lower-limb amputations occur in people with diabetes3
  • Hospital discharges for lower-extremity amputation due to diabetes were 55,000 in 1988 and 68,000 in 20098

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Cost of DFUs and lower-limb amputations

  • In 2001, the overall cost of diabetic peripheral neuropathy and its complications (DFU and lower-extremity amputation) was almost
    $11 billion9
  • In 2008, the average cost of treating a DFU patient was $45,301 for the 2-year period after diagnosis10,11
  • The cost of care for patients receiving an amputation is estimated to be $52,000 per year12
  • Two-thirds of diabetes-related amputations are paid through Medicare13

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Fight to reduce amputations

DFUs are a national medical emergency, with 65,700 nontraumatic lower-limb amputations performed in people with diabetes in 20063

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DFU patient education

We know you're actively engaged in the fight, and we encourage you to continue to counsel patients about:

  • Nutrition and exercise to improve blood glucose
  • Proper care of DFUs
  • The importance of offloading
  • When advanced treatment is needed
  • Prevention of recurrence after a DFU has healed by:
  • — Avoiding foot cuts and injuries
    — Educating your patients about the role of neuropathy in foot injury
    — Continue using prescribed diabetic footwear

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Treating Patients with DFU's

  1. Diabetic foot. Medline Plus website. www.nlm.nih.gov/medlineplus/diabeticfoot.html. Updated June 4, 2013. Accessed July 3, 2013.
  2. CDC features—living with diabetes: keep your feet healthy. Centers for Disease Control and Prevention website. www.cdc.gov/Features/DiabetesFootHealth/. Updated April 2, 2012. Accessed July 3, 2013.
  3. National diabetes fact sheet, 2011. Centers for Disease Control and Prevention website. www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. Accessed July 3, 2013.
  4. Reiber GE, Ledoux WR. Epidemiology of diabetic foot ulcers and amputations: evidence for prevention. In: Williams R, Herman W, Kinmonth AL, Wareham NJ, eds. The Evidence Base for Diabetes Care. West Sussex, England: John Wiley & Sons, Ltd.;2002:641-665.
  5. Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputations in diabetes. In: Bowker JH, Pfeifer MA, eds. Levin and O'Neal's The Diabetic Foot. 6th ed. Philadelphia, PA: Mosby Elsevier;2011:409-428.
  6. Do you know the health risks of being overweight? Weight-control Information Network website. http://win.niddk.nih.gov/publications/health_risks.htm. Updated March 26, 2013. Accessed July 3, 2013.
  7. Diabetes Data & Trends. Centers for Disease Control and Prevention website. http://apps.nccd.cdc.gov/DDTSTRS/default.aspx. Accessed July 3, 2013.
  8. Number (in thousands) of hospital discharges for nontraumatic lower extremity amputation with diabetes as a listed diagnosis, United States, 1988-2009. Centers for Disease Control and Prevention website. www.cdc.gov/diabetes/statistics/lea/fig1.htm. Updated March 6, 2012. Accessed July 3, 2013.
  9. Gordois A, Scuffham P, Shearer A, Oglesby A, Tobian JA. The health care costs of diabetic peripheral neuropathy in the U.S. Diabetes Care. 2003;26(6):1790-1795.
  10. Ramsey SD, Newton K, Blough D, et al. Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care. 1999;22(3):382-387.
  11. Department of Labor Statistics. CPI detailed report. Data for November 2008.
  12. Margolis DJ, Malay DS, Hoffstad OJ, et al. Economic burden of diabetic foot ulcers and amputations. Diabetic Foot Ulcers. Data Points #3 (prepared by the University of Pennsylvania DEcIDE Center, under Contract No. HHSA290200500411). Rockville, MD: Agency for Healthcare Research and Quality. January 2011. AHRQ Publication No. 10(11)-EHC009-2-EF.
  13. Economic and health costs of diabetes. HCUP Highlights. Rockville, MD: Agency for Healthcare Research and Quality. January 2005. AHRQ Publication No. 05-0034.
  14. Armstrong DG, Wrobel J, Robbins JM. Guest Editorial: are diabetes-related wounds and amputations worse than cancer? Int Wound J. 2007;4(4):286-287.
  15. Position statement—the diabetic foot. May 2005. International Diabetes Federation website. www.idf.org/position-statementdiabetic-foot. Accessed July 10, 2012.
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