by the WoundSource Editors
Background and Prevalence of Diabetic Foot Ulcers
Diabetes-related foot complications, including diabetic foot ulcers (DFUs), are leading causes of non-traumatic lower extremity amputation. Of the approximately 420 million adults in the United States with diabetes mellitus, one fourth will develop at least one DFU.1,2 DFUs are preceded by a compendium of risk factors, including the presence of neuropathy, external trauma, infection, effects of ischemia from concomitant peripheral arterial disease, malnutrition, and poor hygiene or self-care, among others. In 80% of patients, DFU is a precursor to some degree of lower extremity amputation.3 And, for these patients who have undergone amputation, their risk for further amputation becomes double that of a patient without diabetes. The mortality rate following a diagnosis of diabetic foot ulceration is 5% in the first year. The five-year mortality rate is 50% and rises to 70% after amputation.4 Once healed, 40% of DFUs will recur within 12 months, nearly 70% at three years, and nearly 75% at five years.5
Evidence-Based Management of Diabetic Foot Ulcers
These recommendations are aligned with the Infectious Disease Society of America 2012 practice guidelines and the 2016 joint guidelines of the Society for Vascular Medicine and the American Podiatric Medical Association. Multidisciplinary care is crucial for patients with DFU, and it should be carried out by a multidisciplinary team, with the previously reviewed items included as a total plan of care. Even after a patient’s ulceration is resolved, the patient is at high risk for DFU recurrence. Some literature has begun to refer to this resolution as “remission,” which better captures the concept that ulceration may recur. Long-term goals are to engage the patient in adequate preventive care and encourage the patient’s maximum activity levels.11
1. Alavi A, Sibbald RG, Mayer D, et al. Diabetic foot ulcers: part II. Management. J Am Acad Dermatol. 2014;70(1):21.e1–24; quiz 45.
2. World Health Organization. Global Report on Diabetes. Geneva, Switzerland: World Health Organization; 2016. http://apps.who.int/iris/bitstream/handle/10665/204871/9789241565257_eng.... Accessed August 6, 2018.
3. Chadwick P, Edmonds M, McCardle J, Armstrong D. International best practice guidelines (IBPG): wound management in diabetic foot ulcers. Wounds International. 2013. http://www.woundsinternational.com/best-practices/view/best-practice-gui.... Accessed August 6, 2018.
4. National Institute for Health and Care Excellence. Type 2 diabetes in adults: management. NICE guideline NG 28. London, United Kingdom: National Institute for Health and Care Excellence; 2015. https://www.nice.org.uk/guidance/ng28. Accessed August 6, 2018.
5. Armstrong DG, Boulton AJM. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367–75.
6. Driver VR, Fabbi M, Lavery LA, et al. The costs of diabetic foot: the economic case for the limb salvage team. J Vasc Surg. 2010;52(3 Suppl):17S–22S.
7. Santema TB, Poyck PP, Ubbink DT. Skin grafting and tissue replacement for treating foot ulcers in people with diabetes. Cochrane Database Syst Rev. 2016;(2):CD011255.
8. Martí-Carvajal AJ, Gluud C, Nicola S, et al. Growth factors for treating diabetic foot ulcers. Cochrane Database Syst Rev. 2015;(10):CD008548.
9. Alavi A, Sibbald RG, Mayer D, et al. Diabetic foot ulcers: part I. Pathophysiology and prevention. J Am Acad Dermatol. 2014;70(1):e1–18.
10. Spencer S. Pressure relieving interventions for preventing and treating diabetic foot ulcers. Cochrane Database Syst Rev. 2000;(3):CD002302.
11. Hingorani A, LaMuraglia GM, Henke P, et al. The management of diabetic foot: a clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg. 2016;63(2 Suppl):3S–21S.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.