Epidemiology and Health Care Costs of Diabetic Foot Problems

The frequency of nontraumatic lower limb amputations in persons with diabetes has increased in the United States over the last decade. Currently two-thirds of all lower limb amputations occur in individuals with diagnosed diabetes. High geographic variation in age, sex, and race-adjusted amputation rates across U.S. populations suggest that important differences in practice patterns exist and that some patients may be receiving suboptimal care. Amputations reduce patient function and quality of life and place a heavy burden on individuals, families, and health care systems. In this chapter the epidemiology and risk factors for two major diabetic foot problems, ulcers and lower limb amputations, are described. Foot ulcer and amputation hospital discharge data are presented from two major U.S. surveys, the Nationwide Inpatient Sample (NIS), a database that also includes utilization and charge information, and the National Hospital Discharge Survey (NHDS) (1,2). Comparisons between persons with and without diabetes are clearly specified. Findings from analytic and experimental studies that used multivariable modeling techniques to determine risk factors are presented. The chapter concludes with information on the economic impact of diabetic foot problems.