Diabetic foot facts

1 in 11 adults has diabetes

In 2017, approximately 425 million people of the global adult population have diabetes.

By 2045 this will rise to 629 million.

Some regions will be more affected than others (see Table 1).

Diabetes can increase the overall risk of dying prematurely

Diabetes was the seventh leading cause of death in 2016.^1,2

Diabetes can lead to complications

Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower-limb amputation.

Worldwide, every 20 seconds a limb is lost due to diabetes

People with diabetes are 10 to 20 times more likely to experience an amputation compared to those who do not have diabetes.

Diabetes can damage the nerves, in particular those in the feet

Almost 80% of people with diabetes have numbness in their feet (peripheral diabetic neuropathy). Nerve damage may reduce people’s awareness to injuries and may lead to a foot ulcer. Up to 25% of patients with diabetes who have impaired sensation in their feet may develop a foot ulcer in their lifetime.

1 in 7 people with diabetes will develop a foot ulcer

The prevalence of diabetic foot ulceration varies greatly between different countries³, whereas for many regions, it is not fully known (see Table 2)

Up to 85% of all lower-limb amputations are preceded by a foot ulcer

People with diabetic foot ulcer should be promptly referred to a foot protection team for appropriate management.

People with diabetic foot ulcers who are referred late for expert assessment are less likely to be alive and ulcer-free at 12 and 24 weeks.⁴ Men with diabetic foot ulcer and lower extremity amputation are twice more likely to die compared with women.⁵

Life expectancy following a lower limb amputation is significantly reduced. Almost one-quarter of people die within 30-days of amputation, almost half at 1 year and up to 80% in 5 years.⁶ The 5-year survival rate after a lower-limb amputation is lower than that in common cancers, noticeably demonstrating the frailty of this population.

Diabetic foot disease poses a significant economic burden

Worldwide diabetic foot disease is a costly complication. Regional differences in treatment costs of diabetic foot complications are summarised in a recent systematic review.⁷

Data from a multicentre European study reported that the estimated annual cost for managing a diabetic foot ulcer is $ 13,561. The cost of amputation ranges between $ 35,000 and $ 45,000 in the developed countries, whereas the cost of amputation in developing countries is substantially lower. Despite the reported difference, with the expected rise in the prevalence of diabetes worldwide, treatment costs of diabetic foot disease will pose globally an additional burden to society and the projected treatment costs will be immense.

The time to act is now ⁸

Research into the diabetic foot care has shown that up to 85% of lower extremity amputations are preventable. For this, the availability of effective services for people with diabetes is of paramount importance. The provision of adequate foot care for people with diabetes requires sufficient knowledge and skills, funding and governmental support.

The key strategic priority of D-Foot International includes the improved worldwide survival of the diabetic foot with an overall goal of achieving a global reduction of diabetes-related lower-extremity amputations.

References

1. IDF Diabetes Atlas Eighth edition, 2017.

2. Global report on diabetes. World Health Organization, 2016.

3. Pengzi Zhang, Jing Lu, Yali Jing, Sunyinyan Tang, Dalong Zhu & Yan Bi (2017) Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis, Annals of Medicine, 49:2, 106-116, DOI: 10.1080/07853890.2016.1231932).

4. Young B, Jeffcoate W. The National Diabetes Footcare Audit of England and Wales: an overview. The Diabetic Foot Journal 2017; 20(4): 235–8.

5. Khalid Al-Rubeaan, Mohammad K. Almashouq, Amira M. Youssef, Hamid Al-Qumaidi, Mohammad Al Derwish, Samir Ouizi, Khalid Al-Shehri, Saba N. Masoodi. All-cause mortality among diabetic foot patients and related risk factors in Saudi Arabia. PLoS One. 2017; 12(11): e0188097.

6. L.V. Fortington, J.H.B. Geertzen, J.J. van Netten, K. Postema, G.M. Rommers, P.U. Dijkstra Short and Long Term Mortality Rates after a Lower Limb Amputation Eur J Vasc Endovasc Surg. 2013 Jul;46(1):124-31. doi: 10.1016/j.ejvs.2013.03.024. Epub 2013 Apr 28).

7. Ioannis Petrakis, Ilias J Kyriopoulos, Alexandros Ginis & Kostas Athanasakis (2017) Losing a foot versus losing a dollar; a systematic review of cost studies in diabetic foot complications, Expert Review of Pharmacoeconomics & Outcomes Research, 17:2, 165-180, DOI: 10.1080/14737167.2017.1305891.

8. Put feet first. Diabetes and foot care.

Table 1

Adult population living with diabetes (in millions)

IDF Diabetes Atlas Eighth edition 2017

Table 2

Prevalence of diabetic foot ulcer in different countries – data from a recent systematic review³