Onychomycosis in a special patient population: focus on the diabetic.

Foot problems are a major cause of morbidity, mortality and disability in diabetic patients. Diabetes mellitus is a relatively common disorder that affects over 16 million people in the United States.1 The World Health Organization predicts that the world population of diabetics will double to over 200 million people by the year 2010.2 Diabetes affects patients of all ages and in all socioeconomic segments of the population. There are over 625 000 newly diagnosed diabetics in the US each year.3 There is a high cost associated with diabetes. The health care costs due to morbidity and complications of diabetes mellitus are higher for diabetics than the general population. In addition, there are indirect costs to society from diabetic complications resulting in loss of productivity. Diabetics utilize health care resources at a rate three times higher than the average American. When evaluated in terms of outpatient contacts with health care providers, diabetics have 15.5 encounters per person compared to 5.5 contacts per year for the general population.4 Diabetes is the most common reason for nontraumatic lower extremity amputations in the US. There were 50 000 lower extremity amputations in diabetics in one year. Foot ulcers preceded amputations 85% of the time in diabetics.5 This places an enormous burden on the resources for health care. In addition, there is up to 68% mortality in diabetics within 5 years of lower extremity amputation.6