Prevention of diabetic foot ulcer.

Abstract

It is estimated that on an average 7% of the world population are diabetics now and this number is estimated to increase to 8.3% by 2030. It is also estimated that 80% of the diabetics patients live in developing countries.[1] On an average every 30 s an extremity is amputated due to complications of diabetes mellitus (DM) and the majority of these amputations are secondary to foot ulcers.[2] Diabetic foot ulcer (DFU) is not only a patient problem but also a major health care concern throughout the world. Diabetic foot ulcer is one of the common and serious complications in diabetic patients. Treatment of infection in diabetic ulcer is difficult and expensive. Patients usually need to take long-term medications or become hospitalized for an extended period of time. It is estimated that usually 15-25% of diabetic patients develop DFU during their life-time.[3] On the other hand, more than 70% of patients who have developed DFU, experience an exacerbation of the disease in the next 5 years.[4] The ulcer usually appears in the same extremity or the extremity of the opposite side; at least a quarter of these ulcers do not heal.[5,6] If an ulcer develops unfortunately, the treatment is challenging and need long duration. Teamwork consists of orthopedic surgeon, endocrinologist, infectious disease physician and a trained nurse in dressing is necessary to care for the wound. It is also advisable to add a podiatrist to the team if one is available. DFU treatment is expensive. On an average, the treatment cost for wounds with Wagner grade I in five industrialized countries was $3096 in 2010. However, if the wound becomes complicated and amputated, the cost will rise to almost $107900.[7] Therefore, based on the noble quote in health care profession “prevention is better than the treatment of the disease,” Diabetic patients and health care providers to diabetic patients should familiarize themselves with the principals of diabetic foot ulcer prevention. The training methods should be designed in a manner that diabetic patients understand and perform the foot care as it is intended. Now the goal should be based on decreasing the amputation rate in diabetic patients, in addition to adequate training of the patients and the team providing care to the patients. The periodic close monitoring of the patient by the health care providers should also be considered. It is important to note the increased prevalence of type two DM in children and adolescences, which by itself is a worldwide health problem. As a result, we unfortunately should expect the higher rate of micro and macro vascular complications of diabetes and increase rate of DFU in younger ages.[8]