Incidence, outcomes, and cost of foot ulcers in patients with diabetes

• Published in: Diabetes care Vol. 22; no. 3; pp. 382 - 387
• Main Authors: RAMSEY, S. D, NEWTON, K, BLOUGH, D, MCCULLOCH, D. K, SANDHU, N, REIBER, G. E, WAGNER, E. H
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.03.1999
• Subjects: Aged; Algorithms; Amputation; Associated diseases and complications; Automation; Biological and medical sciences; Cohort Studies; Cost accounting; Cost estimates; Decision support systems; Diabetes; Diabetes Complications; Diabetes Mellitus - economics; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Foot Ulcer - economics; Foot Ulcer - epidemiology; Foot Ulcer - etiology; Foot Ulcer - surgery; Health Care Costs; Health care policy; Health maintenance organizations; Health Services - statistics & numerical data; Health services utilization; HMOs; Humans; Incidence; Leg ulcers; Male; Medical records; Medical sciences; Middle Aged; Morbidity; Osteomyelitis - etiology; Patients; Pharmacy; Research design; Retrospective Studies; United States; North America; America; Endocrinopathy; Human; Nervous system diseases; Prognosis; Diabetes mellitus; Peripheral neuropathy; Epidemiology; Incidence; Foot; Health economy; Cohort study; Disease of the foot; Complication; Ulcer; Peripheral nerve disease; Cost analysis
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.22.3.382

Incidence, outcomes, and cost of foot ulcers in patients with diabetes. S D Ramsey , K Newton , D Blough , D K McCulloch , N Sandhu , G E Reiber and E H Wagner Department of Medicine, University of Washington 98195, USA. Abstract OBJECTIVE: To determine the incidence of foot ulcers in a large cohort of patients with diabetes, the risk of developing serious complications after diagnosis, and the attributable cost of care compared with that in patients without foot ulcers. RESEARCH DESIGN AND METHODS: Retrospective cohort study of patients with diabetes in a large staff-model health maintenance organization from 1993 to 1995. Patients with diabetes were identified by algorithm using administrative, laboratory, and pharmacy records. The data were used to calculate incidence of foot ulcers, risk of osteomyelitis, amputation, and death after diagnosis of foot ulcer, and attributable costs in foot ulcer patients compared with patients without foot ulcers. RESULTS: Among 8,905 patients identified with type 1 or type 2 diabetes, 514 developed a foot ulcer over 3 years of observation (cumulative incidence 5.8%). On or after the time of diagnosis, 77 (15%) patients developed osteomyelitis and 80 (15.6%) required amputation. Survival at 3 years was 72% for the foot ulcer patients versus 87% for a group of age- and sex-matched diabetic patients without foot ulcers (P < 0.001). The attributable cost for a 40- to 65-year-old male with a new foot ulcer was $27,987 for the 2 years after diagnosis. CONCLUSIONS: The incidence of foot ulcers in this cohort of patients with diabetes was nearly 2.0% per year. For those who developed ulcers, morbidity, mortality, and excess care costs were substantial compared with those for patients without foot ulcers. The results appear to support the value of foot-ulcer prevention programs for patients with diabetes.