epidemiology diabetic foot & higher level amputations dfsi oct 2006 dr. sharad pendsey nagpur
TRANSCRIPT
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EPIDEMIOLOGY DIABETIC FOOT &
HIGHER LEVEL AMPUTATIONS
DFSI Oct 2006
DR. SHARAD PENDSEY
NAGPUR
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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
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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
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MAGNITUDE OF THE PROBLEM GLOBAL
Every 30 seconds a leg is lost somewhere in the world,
due to diabetes
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DIABETIC FOOT INFECTIONS
SOCIOECONOMIC FACTORS : Barefoot walking Inappropriate footwear-Hawaii slippers Lack of awareness in patients & doctors Faith healers & alternative medicine Home surgery
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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 pa
tien
ts
n=7400
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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 pa
tien
ts
n=7400
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TYPES OF FOOT LESIONS
Neuropathic Foot 90 % Extrinsic 70 %
Intrinsic 30 %
Neuroischaemic Foot 10 %The scenario would change with longevity
& longstanding DM
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EPIDEMIOLOGICAL ASPECTS OF THE DIABETIC FOOT
Western Our Series
Prevalence 3% 3.61%
Mean Age 68 53.55
F/M Ratio 1:27 1:3
PVD 40-60% 4-8%
Cost of treatment of foot ulcer(US$)
Diagnosis to healing 14,627 500Ref: Pendsey SP. Int.J.Diab.Dev.Countries(1994),vol.14
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EPIDEMIC OF DIABETES
38 million diabetics in India
Type 1 diabetes only 1 to 3%
Diabetic foot is rare in type 1 diabetics &
constitute less than 0.5% of all cases
In Sweden prevalence of Diabetic foot
ulcer in type 1 is 10 % & type 2 is 9%Borssen, Diabetic Med. 1991,7,438-444
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THE DIABETIC FOOT
TRIPLE JEOPARDY
NEUROPATHY
ISCHAEMIA
INFECTION
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DIABETIC FOOT ULCERS
40-80% of ulcers eventually get infected 25-50% of infections require minor foot amputation And 10-40% require major amputation
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REALITIES 40,000 legs are amputated every year
Commonest indication -
Infected Neuropathic Foot
(potentially preventable)
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MORTALITY &
LEG AMPUTATIONS
Peri-Operative 10%
30% of amputees die within 1 year
50% of amputees die within 3 years
50% of amputees undergo contralateral amputation within 5 years
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EPIDEMIOLOGICAL ASPECTS OF THE DIABETIC FOOT
Western Our Series
Mean Age at amputation 75yrs 61.25yrs
Mortality at 2yrs 40% 16%
Contralateral amputation 30-50% 11.11%
AK:BK Amputation 1:2 1:17
Cost of major amputation 73,702 2000
(US$)Ref: Pendsey SP. Int.J.Diab.Dev.Countries(1994),vol.14
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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
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ANALYSIS OF AMPUTATIONS
Major Amputations 45
Trans femoral (AK) 4 8.88%
Trans tibial (BK) 41 91.11%
Total Number = 1283
Year 2000 – 2005
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ANALYSIS OF AMPUTATIONS
Major Amputations 45
Contralateral 2 4.44%
Mortality at 5 years 9 20%
Total Number = 1283
Year 2000 – 2005
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Ethnic origin Amputation Rate
Asians 3.4/10,000
Caucasians 14.2/10,000
Gujral et al. Diabetic Med. 1992,117,97-105
AMPUTATION RATES
In individuals with diabetes in UK
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FUTURE SHOCK
Longevity of people with DM
Type 1 & 2 DM > 30 yrs duration
Longterm complications of DM
Neuroischaemic feet
Charcot foot
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FUTURE SHOCK
Leg amputations
AK Amputations
Bilateral Amputees
Mortality after Amputation
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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
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