The Costs of Diabetic Foot Ulcers

The Costs of Diabetic Foot Ulcers

A diabetic foot ulcer (DFU) is a devastating complication of diabetes that exacts a terrible cost on patients, families, and society. Diabetic foot ulcers are more likely to occur in the setting of associated diabetic complications of peripheral vascular disease and peripheral neuropathy. These comorbidities also hinder the healing process, leading to chronic non-healing wounds.

The treatment of these wounds is intense and expensive. For recalcitrant wounds, amputation may be necessary. Amputation and subsequent care is quite costly. Barshes et al. (2013) estimated the economic cost of diabetic lower extremity complications at 17 billion dollars annually. This staggering cost is comparable to the five costliest cancers in the United State (figure 1). The development of a DFU is associated with a poor outcome, with 5-year mortality rates as high as 50% (Braun, Fisk, Lev-Tov, Kirsner, & Isseroff, 2014). In addition to these economic and survival costs, DFU is associated with reduced quality of life, a higher incidence of anxiety, and depression (Laiteerapong et al., 2011; Singh et al., 2009). These issues are not surprising, given the impaired mobility and reduced independence associated with DFU and amputation (Barshes et al., 2013).

DFU is preventable and treatable. The American Diabetes Association (ADA) (2004) has issued recommendations for the prevention of diabetic foot ulcers, including: (a)  monitor  feet daily, (b)  have professional preventive care foot examinations at least annually, (c) smoking cessation to prevent peripheral vascular disease, and (d) glycemic control to delay the onset of peripheral neuropathy. In addition, clinicians should educate patients regarding the importance of protective sensation and the hazards of peripheral neuropathy, encourage patients to wear only properly fitting footwear, and remind patients to break in new shoes gradually (ADA, 2004). What can you do to help your patients, family, or friends with diabetes avoid this serious complication?

Figure 1. Annual economic cost of diabetic limb complications compared with the five most costly cancers in the United States. Adapted from “The system of care for the diabetic foot: objectives, outcomes, and opportunities,” by Barshes, N. R., Sigireddi, M., Wrobel, J. S., Mahankali, A., Robbins, J. M., Kougias, P., & Armstrong, D. G., 2013, Diabetic Foot & Ankle, 4. Copyright 2013 Neal Barshes et al.

References

American Diabetes Association. (2004). Preventive foot care in diabetes. Diabetes Care, 27(1), 563-564. http://dx.doi.org/ 10.2337/diacare.27.2007.S63

Barshes, N. R., Sigireddi, M., Wrobel, J. S., Mahankali, A., Robbins, J. M., Kougias, P., & Armstrong, D. G. (2013). The system of care for the diabetic foot: objectives, outcomes, and opportunities. Diabetic Foot & Ankle, 4 http://dx.doi.org/10.3402/dfa.v4i0.21847

Braun, L., Fisk, W., Lev-Tov, H., Kirsner, R., & Isseroff, R. (2014).  Diabetic foot ulcer: An evidence-based treatment update.  American Journal of Clinical Dermatology, 15(3), 267-281.  http://dx.doi.org/ 10.1007/s40257-014-0081-9.

Laiteerapong, N., Karter, A., Liu, J., Moffet, H., Sudore, R., Schillinger, D., & ... Huang, E. (2011). Correlates of quality of life in older adults with diabetes: The diabetes & aging study. Diabetes Care, 34(8), 1749-1753. http://dx.doi.org/10.2337/dc10-2424

Singh, R., Ripley, D., Pentland, B., Todd, I., Hunter, J., Hutton, L., & Philip, A. (2009). Depression and anxiety symptoms after lower limb amputation: The rise and fall. Clinical Rehabilitation, 23(3), 281-286. http://dx.doi.org/10.1177/0269215508094710