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 pat

ient

s

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 pat

ient

s

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 SeriesPrevalence 3% 3.61%Mean Age 68 53.55F/M Ratio 1:27 1:3PVD 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 casesIn 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 SeriesMean Age at amputation 75yrs 61.25yrsMortality at 2yrs 40% 16%Contralateral amputation 30-50% 11.11%AK:BK Amputation 1:2 1:17Cost 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 RateAsians 3.4/10,000Caucasians 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