economic burden diabetic foot l 2a

1. Economic Burden of Diabetic Foot
Dr Sanjeev Kelkar
Head, Project Management Group
Secretary DFSI
October 2007
MSD Training Program
Information of this presentation courtesy
Dr Anil Kapur of WDF Denmark

2. Economic Burden of Diabetic Foot
Even those patients with diabetes having ready
access to health care and are provided with
education on foot care, 9% develop foot
infections in a two year follow up,
(Lavery LA, et al, Risk factors for foot infections in persons with
diabetes mellitus, Diabetes Care, 2006,; 29:1288-93)
This is an English study

3. Temporal Prevalence in Urban South India
5.0
8.2
11.6
14.2
R
2
= 0.9971
0
2
4
6
8
10
12
14
16
18
20
1988 1992 1996 2000
Kudremukh
Chennai
Chennai
Chennai
Bangalore
Hyderabad
Ramachandran A et al

4. Diabetes Mellitus- Genetics
Risk of Diabetes
- F/H/O Diabetes
- One parent diabetic
- One parent diabetic and
other from a diabetic family
Family History
20 %
40 %
70 %
V Mohan & KGMM AlbertiV Mohan & KGMM Alberti
International Textbook of Diabetes Mellitus,1992,178.International Textbook of Diabetes Mellitus,1992,178.
• Family history significant predictor of Diabetes

5. Presenting Symptoms
Symptoms All Type 1 Type 2
Tiredness / Fatigue 50.7% 46.5% 51.0%
Excess Urination 43.3% 59.2% 42.4%
Excess Thirst/Hunger 38.2 % 52.1% 37.4%
Weight Loss 19.7% 34.4% 18.9%
Nausea/ Abdom. Pain 18.0% 17.8% 16.5%
Non Healing Wound 7.4% 7.4% 7.4%
Others 2.1% 2.1% 2.1%
Skin Infection 1.9% 3.2% 1.8%
Heart Problems 1.3% 0.7% 1.3%
Loss of Sensation 0.4% 0.4% 0.4%
CODI Study

6. Test All Type 1 Type 2
Urine 93.8% 97.9% 93.6%
FBS 91.8% 94.7% 91.6%
PPBS 93.2% 96.1% 93.0%
OGTT 17.9% 19.1% 17.8%
GHb 7.6% 18.4% 7.0%
Serum Lipids 7.4% 9.9% 7.3%
Kidney Function 11.1% 17.4% 10.8%
X-rays 16.8% 24.5% 16.4%
ECG 25.5% 38.3% 24.8%
Others 3.3% 4.3% 3.3%
BP Measurement 54.3% 51.8% 54.4%
Foot Examination 7.5% 11.7% 7.2%
Eye Examination 35.1% 37.6% 35.0%
Lab Tests / Clinical Examination
Since Diagnosis
CODI Study

7. Late Complications
39%
31%
7% 3% 1%
Types of Complications
Foot Eye MI Stroke ESRD
Number of Complications
46%
30%
10%
14%
Nil One Two Three+
Does Not Include
•Hypertension (27%)
•Proteinuria (8%)
•Elevated Creatinine (4%)
•Lipid Abnormalities (54%)

8. CODE 2: Effect of complications on per patient costs
0
1
2
3
4
Costimpactfactor
None Microvascular Macrovascular Both
Without complications With complications
1.7 X
2.0 X
3.5 X
Lucioni C et al. PharmacoEconomics- Italian Research Articles, 2000 2(1):1-21
None Microvascular Macrovascular Both

9. Effect Of Patient Education On Amputation
Rates
Knee & Above
12%
15%
5%
46%
35%
60%
Toe & Metatarsal
Below Knee
No Education
Education
University Hospital of Geneva 1979-1989. All comparisons p<0.001. Assal JP et
al. Diabete Metab 1993.

10. CODI Study / AKap/ NNEF ORG
Centre for Social Research
Hospitalization Rate
Complication Specific
CODI Study / AKap/ NNEF ORG
Centre for Social Research
Total Mean Duration of Hospitalization
Cause Specific

11. CODI Study / AKap/ NNEF ORG
Centre for Social Research
Total Mean Hospitalization Cost
Cause Specific

12. CODI Study / AKap/ NNEF ORG
Centre for Social Research
Productivity Loss
Problems at Work

13. Classification of Diabetic foot Wounds
 Several available – none universally
acceptable
 Wagner – Meggitt six grade classification
by depth of the ulcer and extent of gangrene
 The University of Texas Classification
grades wounds by the ulcer depth and then
stages by presence of infection and
ischemia

14. Classification of Diabetic foot Wounds
 S(AD) grades wound in five categories
depending upon the size which includes
area and depth, in addition to the presence
of sepsis, arteriopathy, and denervation
 PEDIS by the International working group on
the Diabetic Foot – grading on
Perfusion, Extent, Depth, Infection and
Sensation

15. Classification of Diabetic foot Wounds
 The Infectious Diseases Society of America
 Subdivides infected diabetic foot wounds in
mild ie restricted involvement of skin and
subcutaneous tissue
moderate ie, more extensive or affecting
deeper tissues
severe ie,accompanied by systemic signs of
infection or metabolic instability

16. Classification of Diabetic foot Wounds
 Mike Edmonds – Ali Foster
 Normal Foot
 High risk foot
 Ulcerated foot
 Infected foot
 Ischemic foot
 Gangrenous foot

17. Classification of Diabetic foot Wounds
 The purpose is as for all classifications
 To be able to describe as closely as
possible, to analyse such hopefully accurate
descriptions of wounds in comparing results
 Overlaps notwithstanding comparisons
across studies may be difficult