DFU Research Funding Gaps: 'A Clear And Present Medical And Fiscal Calamity'

David G. Armstrong DPM MD PhD

Although diabetes takes a costly toll, literally and figuratively, on the foot and ankle, there is a stunning gap in lower extremity diabetes research funding.1

Our recent study, published in Diabetes Care, examined U.S. National Institutes of Health funding for diabetes and diabetic foot ulcers. Our research revealed total spending of $7.1 billion in funding for overall diabetes research from 2002 to 2011 with only $11.8 million, or 0.17 percent, reserved for research on diabetic foot ulcers. As we note in the study, this is a 604-fold disparity.

Furthermore, the study reveals a similar gap in funding in the United Kingdom. Diabetes UK approved just one grant application specific to the diabetic foot, representing only 1.7 percent of the total Diabetes UK funding in 2010 and 2011.

Given that a diabetes-related extremity amputation occurs every 20 seconds, the study notes this research disparity is “a clear and present medical and fiscal calamity.”2 The long-term gap here will continue to drive up costs and reduce access to innovative therapies.

How can we start to solve this? The solution is, in a word, mentoring. We need to redouble our efforts to mentor young clinician scientists who will ultimately sit on these study sections with the National Institutes of Health. They will ultimately become committee members in their academic institutions and rise up to be deans and lab directors and board members. Only this investment can lead to real change.

We are very much working on this now but it requires a sea change in how we define ourselves and how we define success in our specialty.


1. Armstrong DG, Kanda VA, Lavery LA. Mind the gap: disparity between research funding and costs of care for diabetic foot ulcers. Diabetes Care. 2013; 36(7):1815-17.

2. International Diabetes Federation, International Working Group on the Diabetic Foot. Diabetes and foot care: time to act. Brussels, International Diabetes Federation, 2005. Available at http://www.idf.org/webdata/docs/T2A_Introduction.pdf .


How can you start? Train the podiatry providers to recognize when amputation is the appropriate choice.

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