Epidemiology of df & higher level amputations

1. EPIDEMIOLOGY
DIABETIC FOOT &
HIGHER LEVEL
AMPUTATIONS
DFSI Oct 2006
DR. SHARAD PENDSEY
NAGPUR

2. 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

3. 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

4. MAGNITUDE OF THE PROBLEM
GLOBAL
Every 30 seconds
a leg is lost somewhere in the world,
due to diabetes

5. DIABETIC FOOT INFECTIONS
SOCIOECONOMIC FACTORS :
 Barefoot walking
 Inappropriate footwear-Hawaii
slippers
 Lack of awareness in patients &
doctors
 Faith healers & alternative medicine
 Home surgery

6. Cross Section of Diabetic Patients
0
20
40
60
80
< 30 30 to 60 60 to 70 70 to 80 > 80
Age in Years
%ofpatients
n=7400

7. Cross Section of Diabetic Patients
0
20
40
60
80
<10 10 to 20 20 to 30 >30
Duration of DM in Years
%ofpatients
n=7400

8. TYPES OF FOOT LESIONS
 Neuropathic Foot 90 %
Extrinsic 70 %
Intrinsic 30 %
 Neuroischaemic Foot 10 %
The scenario would change with longevity
& longstanding DM

9. 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 14,627 500
Ref: Pendsey SP. Int.J.Diab.Dev.Countries(1994),vol.14

10. 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

11. THE DIABETIC FOOT
TRIPLE JEOPARDY
 NEUROPATHY
 ISCHAEMIA
 INFECTION

12. DIABETIC FOOT ULCERS
 40-80% of ulcers eventually get infected
 25-50% of infections require minor foot
amputation
 And 10-40% require major amputation

13. REALITIES
 40,000 legs are amputated every year
 Commonest indication -
Infected Neuropathic Foot
(potentially preventable)

14. 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

15. 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

16. 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

17. ANALYSIS OF
AMPUTATIONS
Major Amputations 45
Trans femoral (AK) 4 8.88%
Trans tibial (BK) 41 91.11%
Total Number = 1283
Year 2000 – 2005

18. ANALYSIS OF
AMPUTATIONS
Major Amputations 45
Contralateral 2 4.44%
Mortality at 5 years 9 20%
Total Number = 1283
Year 2000 – 2005

19. 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

20. FUTURE SHOCK
 Longevity of people with DM
 Type 1 & 2 DM > 30 yrs duration
 Longterm complications of DM
 Neuroischaemic feet
 Charcot foot

21. FUTURE SHOCK
 Leg amputations
 AK Amputations
 Bilateral Amputees
 Mortality after Amputation

22.  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