DIABETES MELLITUS FOOT DIABETES MELLITUS FOOT SYNDROMESYNDROMEDR OTUKOYA AO.SR ENDOCRINOLOGY AND METABOLISM UNIT

OutlineOutlineIntroductionEpidemiology

INTRODUCTIONINTRODUCTIONDefinitionThe foot of a diabetic patient with ulceration, infection and/or

destruction of the deep tissues, associated with neurological

abnormalities and various degrees of peripheral

vascular disease in the lower limb. (WHO/International Working Group on the Diabetic Foot)

INTRODUCTIONINTRODUCTIONAfrica is experiencing a rapid

epidemiological transition with the burden of non-communicable diseases esp. diabetes that will overwhelm the health care systems which is already overburdened by HIV/AIDS, TB and Malaria.

This is due toRapid urbanization and

westernization of lifestyleRapidly decreasing physical activityChanges in dietary habitsAgeing of the population

INTRODUCTIONINTRODUCTION“So how many people with diabetes are there?”

Here are recent estimates of the disease burden due to diabetes and projections for the future.

2003 2025

Europe Africa Europe Africa

Population• Total

• Adult

(20-79 yrs)

872 million

621 million

667 million

295 million

863 million

646 million

1107 million

541 million

Diabetes• No. of people

(20-79 yrs)

• Prevalence

(20-79 yrs)

48.4 million

7.8 %

7.1 million

2.4 %

65 million

7.8 %

19million

4.3 %

Source: International Diabetes Federation and The international Working Group on Diabetes joint publication 2006.

EPIDEMIOLOGYEPIDEMIOLOGY

In 2013, the global prevalence of diabetes was estimated at 382 million (20-70yrs) of which 80% live in low and middle income countries.

This figure is predicted globally to reach 592 million ( 55% increase) by 2035.

EPIDEMIOLOGYEPIDEMIOLOGYIn Africa, total number of

diabetes was 19.8 million in 2013 and will increase to 41.4 million by 2035.

EPIDEMIOLOGYEPIDEMIOLOGYDiabetes foot accounts for 19.5

to 24% of all DM mortality.

Diabetes mellitus foot is the second leading cause of DM related death in Nigeria.

EPIDEMIOLOGYEPIDEMIOLOGY40% - 60% of all non traumatic

lower limb amputation

85% of diabetic related foot amputation are preceded by foot ulcer

4 out of 5 ulcer in diabetics are precipitated by trauma

4% -10% is the prevalence of foot ulcer in diabetics

EPIDEMIOLOGYEPIDEMIOLOGY• IN a study done in Zaria by ZAKARI

et al in 2003• 142 DM patients were admitted over

a 12 months period.• 31% had DM foot.• 61% were male and 39% female.• Right foot affected in 48%• 43% presented with Wagner's grade

4• 11% had amputation• 7% died during hospitalization.

EPIDEMIOLOGYEPIDEMIOLOGY LUTH AND LASUTH DMFS typical in age 50-60 years

80-90% are not registered patients

Case fatality is 28%

Hospital stay between 30-90 days

Cost of treatment between 50,000 to 2,000,000 naira only.

EPIDEMIOLOGYEPIDEMIOLOGYLUTH STATISTICS (2015) A&E Feb till date: 26 pts. M:F ; 1:1.240-82 yrs . Mean : 58yrs4 died in A&E : 15.4% MortalityAll with foot gangrene Ward5 pts. 5.7% of ward admissionM:F : 1:1.5

EPIDEMIOLOGYEPIDEMIOLOGY

Amputations

Up to 20% undergo an ipsilateral amputation within 12 months

Up to 50% undergo a contralateral amputation within 1-3 years; >50% within 5 years

3 year mortality after amputation is 20-50%

EPIDEMIOLOGYEPIDEMIOLOGY(OF AMPUTATION)(OF AMPUTATION)

25-50 % of diabetic foot infections lead to minor amputations

10-40 % require major amputations

10-30 % of patients with a diabetic foot ulcer will go on to amputation

EPIDEMIOLOGYEPIDEMIOLOGY(OF AMPUTATION)(OF AMPUTATION)

1 in 4 of diabetes patient with DM foot require immediate amputation and five years recurrence rates of ulcer is 70%.

ANATOMICAL ANATOMICAL DISTRIBUTIONDISTRIBUTION

~50% of ulcers are on the toes~30-40% are on the plantar

metatarsal head~10-15% are on the dorsum of

the foot~5-10% are on the ankleup to 10% are multiple ulcers

EPIDEMIOLOGYEPIDEMIOLOGYCellulitis occurs 9 times more

frequently in diabetics than non-diabetics

Osteomyelitis of the foot 12 times more frequently in diabetics than non-diabetics

Foot ulcerations and infections are the most common reason for patients with diabetes to be admitted to the hospital

COSTCOST

Cost of diabetic foot management is 12-15% of the total healthcare budget for diabetes in developed countries.

May as high as 40% in developing countries.

These figures do not account for cost of loss of potential working members to the economy and social costs of the inability to support a family.

EPIDEMIOLOGYEPIDEMIOLOGY85% of all diabetic foot related

problems are preventableEvery 20 seconds a limb is lost

due to diabetes somewhere in the world

SUMMARYSUMMARYIn summary I have presented the

definition introduction and epidemiology of DMFS.

Footwear - socksFootwear - socks

REFRENCESREFRENCESOgbera A.O Fasanmade O.A. The

foot at risk in nigerians with diabetes. The nigerian scenario. Int Jendo metab2005;4:165-73

Int working group on DM foot 1999. international consensus on the diabetic foot. The Netherlands. Pp 22-96.