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EPIDEMIOLOGY DIABETIC FOOT & HIGHER LEVEL AMPUTATIONS

EPIDEMIOLOGY DIABETIC FOOT & HIGHER LEVEL AMPUTATIONS. DFSI Oct 2006 DR. SHARAD PENDSEY NAGPUR. MAGNITUDE OF THE PROBLEM GLOBAL.  25% diabetics develop foot ulcers in their life time  Diabetic foot is the commonest indication for hospitalisation

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EPIDEMIOLOGY DIABETIC FOOT & HIGHER LEVEL AMPUTATIONS

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  1. EPIDEMIOLOGY DIABETIC FOOT & HIGHER LEVEL AMPUTATIONS DFSI Oct 2006 DR. SHARAD PENDSEY NAGPUR

  2. MAGNITUDE OF THE PROBLEM GLOBAL 25% diabetics develop foot ulcers in their life time  Diabetic foot is the commonest indication for hospitalisation  Diabetic foot requires longest hospital stay

  3. MAGNITUDE OF THE PROBLEM GLOBAL  Diabetics are 40 times more likely to loose a leg as compared to non diabetics  75% of all leg amputations happen in people with diabetes  About 1 million people loose a leg, every year, due to diabetes

  4. MAGNITUDE OF THE PROBLEM GLOBAL Every 30 seconds a leg is lost somewhere in the world, due to diabetes

  5. DIABETIC FOOT INFECTIONS SOCIOECONOMIC FACTORS :  Barefoot walking  Inappropriate footwear-Hawaii slippers  Lack of awareness in patients & doctors  Faith healers & alternative medicine  Home surgery

  6. n=7400

  7. n=7400

  8. TYPES OF FOOT LESIONS Neuropathic Foot 90 % Extrinsic 70 % Intrinsic 30 % Neuroischaemic Foot 10 % The scenario would change with longevity & longstanding DM

  9. EPIDEMIOLOGICAL ASPECTS OF THE DIABETIC FOOT Western Our Series Prevalence 3% 3.61% Mean Age 68 53.55 F/M Ratio 1:27 1:3 PVD 40-60% 4-8% Cost of treatment of foot ulcer(US$) Diagnosis to healing 14,627 500 Ref: Pendsey SP. Int.J.Diab.Dev.Countries(1994),vol.14

  10. EPIDEMIC OF DIABETES 38 million diabetics in India Type 1 diabetes only 1 to 3% Diabetic foot is rare in type 1 diabetics & constitute less than 0.5% of all cases In Sweden prevalence of Diabetic foot ulcer in type 1 is 10 % & type 2 is 9% Borssen, Diabetic Med. 1991,7,438-444

  11. THE DIABETIC FOOT TRIPLE JEOPARDY  NEUROPATHY  ISCHAEMIA  INFECTION

  12. DIABETIC FOOT ULCERS 40-80% of ulcers eventually getinfected 25-50% of infections require minor foot amputation  And 10-40% require major amputation

  13. REALITIES 40,000 legs are amputated every year  Commonest indication - Infected Neuropathic Foot (potentially preventable)

  14. MORTALITY & LEG AMPUTATIONS  Peri-Operative 10%  30% of amputees die within 1 year  50% of amputees die within 3 years  50% of amputees undergo contralateral amputation within 5 years

  15. EPIDEMIOLOGICAL ASPECTS OF THE DIABETIC FOOT Western Our Series Mean Age at amputation 75yrs 61.25yrs Mortality at 2yrs 40% 16% Contralateral amputation 30-50% 11.11% AK:BK Amputation 1:2 1:17 Cost of major amputation 73,702 2000 (US$) Ref: Pendsey SP. Int.J.Diab.Dev.Countries(1994),vol.14

  16. ANALYSIS OF DIABETIC FOOT CASES Total Number = 1283 Year 2000 – 2005

  17. ANALYSIS OF AMPUTATIONS Total Number = 1283 Year 2000 – 2005

  18. ANALYSIS OF AMPUTATIONS Total Number = 1283 Year 2000 – 2005

  19. AMPUTATION RATES In individuals with diabetes in UK Ethnic origin Amputation Rate Asians 3.4/10,000 Caucasians 14.2/10,000 Gujral et al. Diabetic Med. 1992,117,97-105

  20. FUTURE SHOCK  Longevity of people with DM  Type 1 & 2 DM > 30 yrs duration  Longterm complications of DM  Neuroischaemic feet  Charcot foot

  21. FUTURE SHOCK  Leg amputations  AK Amputations  Bilateral Amputees  Mortality after Amputation

  22. ALERT 50% reduction in leg amputations has been achieved in the Western World 85% amputations are preceded by trivial foot ulcers India might emerge as the country with highest leg amputations in the world

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