DIABETIC FOOT CARE: INVESTING IN PREVENTION IS COST-EFFECTIVE

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DIABETIC FOOT CARE INVESTING IN PREVENTION IS
COST-EFFECTIVE Dr Karel Bakker Chair IDF
Consultative Section IWGDF
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Foot facts worldwide

• Over 1,000,000 amputations per year
• Every 30 seconds a leg is lost to diabetes

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Foot facts

• People with diabetes are 25 times more likely to
  lose a leg than people without the condition
• Throughout the world, up to 70 of all leg
  amputations happen to people with diabetes

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Foot facts

• In developed countries one in every six people
  with diabetes will have an ulcer during their
  lifetime
• In developing countries, foot problems related to
  diabetes are thought to be even more common
• 85 of diabetes-related lower extremity
  amputations are preceded by a foot ulcer

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Pathway to diabetic foot problems
Nerve damage
Poor blood supply
Injury
Ulcer
Infection
Amputation
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Pathway to diabetic foot problems
Nerve damage
Poor blood supply
Injury
Ulcer
Infection
Amputation
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Pathway to diabetic foot problems
Nerve damage
Poor blood supply
Injury
Ulcer
Infection
Amputation
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Pathway to diabetic foot problems
Nerve damage
Poor blood supply
Injury
Ulcer
Infection
Amputation
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Costs of diabetic foot problems (US )

• Ulcer healing 7,000-10,000
• Direct costs of amputation 30,000-60,000

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Costs of diabetic foot problems

• In developed countries diabetic foot care
  accounts for 15-25 of total healthcare resources
  available for diabetes.
• In some developing countries, it has been
  estimated that foot problems may account for as
  much as 40 of the resources available

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Prevention

• Up to 85 of all diabetes-related amputations can
  be prevented
• It is possible to save up to 30 of healthcare
  budget
• Education and podiatry are the most cost
  effective strategies

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Prevention

• In countries where National Diabetes Programmes
  exist, foot clinics are emerging
• EVA project opening of 10 foot clinics in 5
  countries of the Andes (Bolivia, Peru, Ecuador,
  Colombia, Venezuela)
• However
• Podiatric education is still scarce in many
  countries of the SACA Region
• Prevention programmes are still the exception

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What can be done?

• Cornerstones of Prevention
• Regular inspection and examination of feet and
  footwear
• Identification of the high-risk foot
• People with diabetes
• Make sure you have your feet checked periodically
  by a healthcare professional

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What can be done?

• Healthcare professionals

• Risk of neuropathy can be detected by using a 10g
  monofilament
• Palpation of foot pulses is the simplest means of
  identifying peripheral arterial disease

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What can be done?
Cornerstones of Prevention 3. Education of
people with diabetes, family members and
healthcare workers 4. Appropriate
footwear 5. Rapid treatment of all foot problems
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Sponsors WDD Campaign 2005

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Conclusions

• The human and financial consequences of the
  diabetic foot are devastating
• Action is possible and affordable
• Amputations are preventable
• Even in low-resource settings, foot care can
  substantially reduce ulceration and amputation
• Feet should last a lifetime

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Conclusions

• Every 30 seconds a limb is lost to diabetes
  somewhere in the world. . .
• . . . This needs to be changed!