Background
Foot ulcers are one of the main complications of diabetes, with a 15% lifetime risk in all diabetic patients. The incidence of diabetic foot ulcer (DFU) is 1.0% to 4.0% and their prevalence is between 5.3% and 10.5%.1 Approximately 20% of hospital admissions among diabetic patients are the result of foot problems. Without adequate management, there is a high risk of infection, gangrene, amputation, and death. Over 50% of major amputations in the UK are performed in patients with diabetes, and within 3 years of amputation, 50% of patients will die. A multidisciplinary team is mandatory for diabetic patients with foot ulcers, who benefit from accurate and prompt assessment, diagnosis, treatment, and long-term follow-up in order to conserve the foot. Diabetes is the leading cause of lower extremity amputation (LEA) and the rate of LEA among diabetic patients has been 40 times higher than that in nondiabetics.
Good news in 2008
Two recent reports2,3 from the UK indicate that the rate of LEA in diabetic patients has been dramatically reduced in the last 5 to 10 years. Krishnan et al2 reported an impressive reduction in diabetic amputations over 11 years in a defined UK population as a beneficial result of multidisciplinary teamwork and continuous prospective auditing. The incidence of major amputations fell by 62%, from 7.4 to 2.8 per 100 000 of the general population. Total amputation rates also decreased (by 40.3%), but to a lesser extent due to a small increase in minor amputations. Expressed as incidence per 10 000 people with diabetes, total amputations fell by 70%, from 53.2 to 16.0, and major amputations fell by 82%, from 36.4 to 6.7.
