EPIDEMIOLOGY DIABETIC FOOT &
HIGHER LEVEL AMPUTATIONS
DFSI Oct 2006
DR. SHARAD PENDSEY
NAGPUR
MAGNITUDE OF THE PROBLEM GLOBAL
25% diabetics develop foot ulcers in their life time Diabetic foot is the commonest indication for hospitalisation Diabetic foot requires longest hospital stay
MAGNITUDE OF THE PROBLEM GLOBAL
Diabetics are 40 times more likely to loose a leg as compared to non diabetics 75% of all leg amputations happen in people with diabetes About 1 million people loose a leg, every year, due to diabetes
MAGNITUDE OF THE PROBLEM GLOBAL
Every 30 seconds a leg is lost somewhere in the world,
due to diabetes
DIABETIC FOOT INFECTIONS
SOCIOECONOMIC FACTORS : Barefoot walking Inappropriate footwear-Hawaii slippers Lack of awareness in patients & doctors Faith healers & alternative medicine Home surgery
Cross Section of Diabetic Patients
0
20
40
60
80
< 30 30 to 60 60 to 70 70 to 80 > 80
Age in Years
% o
f pa
tien
ts
n=7400
Cross Section of Diabetic Patients
0
20
40
60
80
<10 10 to 20 20 to 30 >30
Duration of DM in Years
% o
f pa
tien
ts
n=7400
TYPES OF FOOT LESIONS
Neuropathic Foot 90 % Extrinsic 70 %
Intrinsic 30 %
Neuroischaemic Foot 10 %The scenario would change with longevity
& longstanding DM
EPIDEMIOLOGICAL ASPECTS OF THE DIABETIC FOOT
Western Our Series
Prevalence 3% 3.61%
Mean Age 68 53.55
F/M Ratio 1:27 1:3
PVD 40-60% 4-8%
Cost of treatment of foot ulcer(US$)
Diagnosis to healing 14,627 500Ref: Pendsey SP. Int.J.Diab.Dev.Countries(1994),vol.14
EPIDEMIC OF DIABETES
38 million diabetics in India
Type 1 diabetes only 1 to 3%
Diabetic foot is rare in type 1 diabetics &
constitute less than 0.5% of all cases
In Sweden prevalence of Diabetic foot
ulcer in type 1 is 10 % & type 2 is 9%Borssen, Diabetic Med. 1991,7,438-444
THE DIABETIC FOOT
TRIPLE JEOPARDY
NEUROPATHY
ISCHAEMIA
INFECTION
DIABETIC FOOT ULCERS
40-80% of ulcers eventually get infected 25-50% of infections require minor foot amputation And 10-40% require major amputation
REALITIES 40,000 legs are amputated every year
Commonest indication -
Infected Neuropathic Foot
(potentially preventable)
MORTALITY &
LEG AMPUTATIONS
Peri-Operative 10%
30% of amputees die within 1 year
50% of amputees die within 3 years
50% of amputees undergo contralateral amputation within 5 years
EPIDEMIOLOGICAL ASPECTS OF THE DIABETIC FOOT
Western Our Series
Mean Age at amputation 75yrs 61.25yrs
Mortality at 2yrs 40% 16%
Contralateral amputation 30-50% 11.11%
AK:BK Amputation 1:2 1:17
Cost of major amputation 73,702 2000
(US$)Ref: Pendsey SP. Int.J.Diab.Dev.Countries(1994),vol.14
ANALYSIS OF DIABETIC FOOT CASES
Major Amputations 45 3.5%
Minor Amputations 256 20%
Salvage of foot 982 76.5%
Total Number = 1283
Year 2000 – 2005
ANALYSIS OF AMPUTATIONS
Major Amputations 45
Trans femoral (AK) 4 8.88%
Trans tibial (BK) 41 91.11%
Total Number = 1283
Year 2000 – 2005
ANALYSIS OF AMPUTATIONS
Major Amputations 45
Contralateral 2 4.44%
Mortality at 5 years 9 20%
Total Number = 1283
Year 2000 – 2005
Ethnic origin Amputation Rate
Asians 3.4/10,000
Caucasians 14.2/10,000
Gujral et al. Diabetic Med. 1992,117,97-105
AMPUTATION RATES
In individuals with diabetes in UK
FUTURE SHOCK
Longevity of people with DM
Type 1 & 2 DM > 30 yrs duration
Longterm complications of DM
Neuroischaemic feet
Charcot foot
FUTURE SHOCK
Leg amputations
AK Amputations
Bilateral Amputees
Mortality after Amputation
50% reduction in leg amputations has been achieved in the Western World
85% amputations are preceded by trivial foot ulcers
India might emerge as the country with highest leg amputations in the world
ALERT