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
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 F/M Ratio 1:27 1:3 PVD 40-60% 4-8% Cost of treatment of foot ulcer(US$) Diagnosis to healing 14, Ref: Pendsey SP. Int.J.Diab.Dev.Countries(1994),vol.14
EPIDEMIC OF DIABETES 38 million diabetics in India Type 1 diabetes only 1 to 3% Diabetic foot is rare in type 1 diabetics & constitute less than 0.5% of all cases In Sweden prevalence of Diabetic foot ulcer in type 1 is 10 % & type 2 is 9% Borssen, Diabetic Med. 1991,7,
THE DIABETIC FOOT TRIPLE JEOPARDY NEUROPATHY ISCHAEMIA INFECTION
DIABETIC FOOT ULCERS 40-80% of ulcers eventually get infected 25-50% of infections require minor foot amputation And 10-40% require major amputation
REALITIES 40,000 legs are amputated every year Commonest indication - Infected Neuropathic Foot (potentially preventable)
MORTALITY & LEG AMPUTATIONS Peri-Operative10% 30% of amputees die within 1 year 50% of amputees die within 3 years 50% of amputees undergo contralateral amputation within 5 years
EPIDEMIOLOGICAL ASPECTS OF THE DIABETIC FOOT Western Our Series Mean Ageat amputation 75yrs 61.25yrs Mortality at 2yrs 40% 16% Contralateral amputation 30-50% 11.11% AK:BK Amputation 1:2 1:17 Cost of major amputation 73, (US$) Ref: Pendsey SP. Int.J.Diab.Dev.Countries(1994),vol.14
ANALYSIS OF DIABETIC FOOT CASES Major Amputations453.5% Minor Amputations25620% Salvage of foot % Total Number = 1283 Year 2000 – 2005
ANALYSIS OF AMPUTATIONS Major Amputations45 Trans femoral (AK)48.88% Trans tibial (BK) % Total Number = 1283 Year 2000 – 2005
ANALYSIS OF AMPUTATIONS Major Amputations45 Contralateral24.44% Mortality at 5 years920% 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, 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