Why This Matters

• DFUs are high-risk events. Up to one-third of patients with diabetes will develop a foot ulcer, and amputation carries a 5-year mortality rate approaching 70%.
• Systemic barriers drive nonhealing. Poor glycemic control, peripheral artery disease, infection, and medication nonadherence significantly worsen outcomes.
• Mobile practice offers a unique advantage. Delivering wound care in the home provides real-time insight into social and behavioral determinants that influence healing and recurrence.

Diabetic foot ulcers (DFUs) remain one of the most devastating and costly complications of diabetes, driving infection, amputation, and mortality across the United States. As care increasingly shifts into the home, mobile wound management is uniquely positioned to confront the systemic barriers that delay healing and worsen outcomes.  

The Scope of the Diabetic Foot Ulcer Crisis

Diabetes affects an estimated 38.4 million people in the United States—approximately 11.6% of the population—with prevalence continuing to rise.¹ Among these individuals, the lifetime risk of developing a diabetic foot ulcer ranges from 19% to 34%.² At any given time, approximately 1.6 million Americans are living with a DFU.³

DFUs are not isolated wounds; they are sentinel events. Roughly 20% of moderate-to-severe DFUs result in amputation.² In the United States, diabetes remains the leading cause of nontraumatic lower-extremity amputation, accounting for over 80% of cases.⁴ Five-year mortality after a diabetes-related amputation approaches 50% to 70%, rivaling or exceeding many malignancies.⁵

For wound care professionals, these statistics underscore a stark reality: DFUs are not simply chronic wounds—they may also be predictors of limb loss and premature death.

The Economic and Health System Impact

The financial burden of DFUs is equally staggering. Direct and indirect costs of diabetes in the United States reached $412.9 billion in 2022, with foot complications representing a significant portion of hospitalizations and expenditures.⁶ Patients with DFUs incur healthcare costs approximately 2.5 times higher than those with diabetes alone.⁷

Hospitalizations for infection, osteomyelitis, and vascular complications are common. Infection complicates more than half of DFUs and precedes up to 85% of diabetes-related amputations.^2,8 Recurrent ulcers are also frequent, with recurrence rates of approximately 40% within one year after healing.²

These data highlight an ongoing cycle of wound development, healing failure, and recurrence—one that strains clinicians, patients, and health systems alike.

Why the Mobile Environment Changes the Equation

Traditional wound care models often rely on episodic, clinic-based encounters. However, the Centers for Disease Control and Prevention (CDC) reports that adults with diabetes are more likely to experience mobility limitations, visual impairment, and socioeconomic barriers that complicate consistent outpatient follow-up.¹

Social determinants of health—including food insecurity, transportation challenges, and medication nonadherence—directly influence glycemic control and wound healing.⁹ Yet these factors are difficult to assess fully in a clinic setting.

Mobile wound management brings clinicians into the patient’s living environment, offering visibility into real-world contributors to nonhealing wounds. The home setting allows for observation of nutritional patterns, medication storage and adherence behaviors, fall risks, pressure sources, and footwear conditions—variables strongly associated with ulcer recurrence and delayed healing.^2,9

As healthcare delivery shifts toward value-based care and hospital-at-home models, mobile practice aligns with broader federal priorities to reduce preventable hospitalizations and improve chronic disease outcomes.¹⁰

Healing Barriers Beyond the Wound Bed

DFU healing is multifactorial. Peripheral neuropathy, peripheral artery disease, infection, and hyperglycemia each independently increase the risk of nonhealing and amputation.² Approximately 50% of patients with DFUs have concomitant peripheral artery disease, significantly worsening prognosis.²

Glycemic control remains suboptimal nationwide. In recent national data, only about half of adults with diagnosed diabetes achieved individualized hemoglobin A1c targets.¹¹ Poor glycemic control is associated with impaired leukocyte function, delayed collagen synthesis, and increased infection risk—all contributors to stalled wound healing.²

Medication adherence in chronic disease management is another critical factor. Across chronic conditions, adherence rates often fall below 50%, contributing to preventable complications and hospitalizations.¹² In the context of DFUs, suboptimal adherence to antidiabetic, antihypertensive, and lipid-lowering therapies compounds vascular risk.

Mobile practice offers the opportunity to evaluate these systemic barriers concurrently with advanced wound interventions. For wound professionals, this dual focus—addressing both the ulcer and the underlying metabolic disease—represents a paradigm shift.

Why This Conversation Is Urgent for Wound Professionals

DFUs are increasing in parallel with diabetes prevalence and an aging population.¹ Without systemic intervention, projections suggest continued growth in diabetes-related complications and amputations.⁴

For clinicians managing complex wounds in the field, the mobile environment is not merely a setting—it is a clinical vantage point. Understanding how to leverage that vantage point to reduce complications, hospitalizations, and amputations is central to improving patient outcomes and meeting evolving quality metrics. As data continue to demonstrate the profound morbidity, mortality, and cost associated with DFUs, exploring models that overcome barriers to healing is not optional—it is imperative.

References

1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2023. US Department of Health and Human Services; 2023.
2. Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367-2375. doi:10.1056/NEJMra1615439
3. Nussbaum SR, Carter MJ, Fife CE, et al. An economic evaluation of the impact, cost, and Medicare policy implications of chronic nonhealing wounds. Value Health. 2018;21(1):27-32. doi:10.1016/j.jval.2017.07.007
4. Geiss LS, Li Y, Hora I, Albright A, Rolka D, Gregg EW. Resurgence of diabetes-related nontraumatic lower-extremity amputation in the young and middle-aged adult U.S. population. Diabetes Care. 2019;42(1):50-54. doi:10.2337/dc18-1380
5. Thorud JC, Plemmons B, Buckley CJ, Shibuya N, Jupiter DC. Mortality after nontraumatic major amputation among patients with diabetes and peripheral vascular disease. J Foot Ankle Surg. 2016;55(3):591-599. doi:10.1053/j.jfas.2016.01.012
6. American Diabetes Association. Economic costs of diabetes in the U.S. in 2022. Diabetes Care. 2023;46(4):958-970. doi:10.2337/dci23-0001
7. Rice JB, Desai U, Cummings AKG, et al. Burden of diabetic foot ulcers for Medicare and private insurers. Diabetes Care. 2014;37(3):651-658. doi:10.2337/dc13-2176
8. Lavery LA, Armstrong DG, Wunderlich RP, et al. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29(6):1288-1293. doi:10.2337/dc05-2425
9. Hill-Briggs F, Adler NE, Berkowitz SA, et al. Social determinants of health and diabetes: A scientific review. Diabetes Care. 2021;44(1):258-279. doi:10.2337/dci20-0053
10. Centers for Medicare & Medicaid Services. Acute Hospital Care at Home Initiative. Updated 2023. Accessed March 11, 2026.
11. Fang M, Wang D, Coresh J, Selvin E. Trends in diabetes treatment and control in U.S. adults, 1999–2018. N Engl J Med. 2021;384(23):2219-2228. doi:10.1056/NEJMsa2032271
12. Cutler RL, Fernandez-Llimos F, Frommer M, Benrimoj C, Garcia-Cardenas V. Economic impact of medication non-adherence by disease groups: A systematic review. BMJ Open. 2018;8:e016982. doi:10.1136/bmjopen-2017-016982