Prevention and Early Intervention for Diabetes Foot Problems
2. The Scope of the Problem continued...
Frequency of Foot Examinations
Examination of the feet by people with diabetes and health care providers is the most basic preventive action to be taken.
In the 1989 National Health Interview Survey (NHIS), 52 percent of all people with diabetes stated that they checked their feet at least daily, but 22 percent stated that they never checked their feet. More self-exams were reported by insulin treated individuals that those who did not use insulin3.
The NHIS also provided information on the frequency of foot examinations made by health professionals. Almost 53 percent of patients with diabetes reported no foot exam by a health professional within the past six months. The frequency of having no foot exam was highest in patients not using insulin (59 percent)3. In a nationwide survey, primary care physicians reported performing semi-annual foot examinations for 66 percent of patients with type 1 diabetes and for 52 percent of patients with type 2 diabetes2. A 1992 review of Indian Health Service medical records showed that close to 50 percent of patients with diabetes had documentation of an annual foot examination7.
Personal and Financial Costs
Diabetes foot disease is a major burden for both the individual and the health care system and may increase as the population ages. Fifteen percent of all patients with diabetes in a population-based study experienced ulcers or sores on the foot or ankle. The prevalence increased with age, especially in patients who were age 30 or under at diagnosis of diabetes8.
Foot disease is the most common complication of diabetes leading to hospitalization. In 1995, foot disease accounted for 6 percent of hospital discharges listing diabetes and lower extremity ulcers, with an average hospital stay of 14.7 days. Cost of care estimates for lower limb amputations in 1992 ranged from $24,000 to $27,000 and from $14,500 to $21,500 for rehabilitation. The average length of hospital stay for these two diagnoses ranged from 18.4 to 20.3 and 16.0 to 23.9 days, respectively3. The total annual cost associated with diabetes foot disease is estimated to be more than $1 billion. This cost does not include surgeons' fees, rehabilitation costs, prostheses, time lost from work, and disability payments9.
After an amputation, the chance of another amputation of the same extremity or of the opposite extremity within 5 years is as high as 50 percent. The 5-year mortality rate after lower extremity amputation ranges from 39 to 68 percent3.