Connecting The Dots Between Diabetic Foot Ulcers, PAD And Dangerous Complications

Desmond Bell, DPM, CWS, FACCWS

Pink ribbon. The juxtaposition of these two words translates into arguably the most recognized symbol anywhere, the looping image firmly embedded in our collective psyche and associated with breast cancer awareness. These words also conjure up a range of thoughts, emotions and an awareness of breast cancer that has transformed this terrible disease into a cause that extends beyond medical research. It is safe to say that minus the ribbon, the color pink alone has come to symbolize breast cancer awareness.

   The pink ribbon has created an awareness that has resulted in a proactive approach and attitude among the general population, especially in regard to prevention and early detection. It is estimated that the five-year mortality rate attributed to breast cancer is approximately 14 to 18 percent.1,2

   Why have I mentioned breast cancer and its associated symbols in a column dedicated to diabetes?

   Simply stated, we must perceive the complications associated with diabetes in the same manner as with breast cancer. It is safe to say that the majority of people, not to mention primary care providers, do not have an understanding of the magnitude of the problem. Typically, there is a lack of correlating catastrophic health events, such as heart attack, stroke and diabetic foot ulcers (DFU) to each other, not to mention disturbing mortality rates in which complications of diabetes are factors.

   If we are to make any significant progress in the healing of diabetic ulcers and simultaneously reducing lower extremity amputations, heart attack and stroke, we must begin the process of linking these complications into one comprehensive issue, instead of the myriad described as “complications from diabetes.”

Raising Awareness Of DFUs Complicated By PAD

The SAGE Group is a research and consulting company specializing in atherosclerotic disease in the lower limbs, specifically peripheral arterial disease (PAD), critical limb ischemia (CLI) and acute limb ischemia. Its most recent research focuses on PAD and diabetic foot ulcers.

   According to the SAGE Group, PAD affects 2 to 3.7 million U.S. citizens with diabetic foot ulcers.3 Additionally, 1 million patients suffer from critical limb ischemia, the most severe and deadly form of PAD.

   Recent research indicates that diabetic ulcers in individuals with PAD are a different disease than ulcers caused by neuropathy alone.4 Among other differences from purely neuropathic ulcers, diabetic foot ulcers in patients with PAD tend to be more severe, are more likely to be infected, are infected by different pathogens, heal less frequently and are more costly to treat, primarily because of a greater number of hospitalizations. All of these factors have implications for the type and success of therapies clinicians employ as well as for the economic burden.

   As a result, the economic burden of diabetic foot ulcers complicated by PAD is higher than in DFUs without significant PAD. In 2009 dollars, treatment costs per episode were over $32,000 for foot ulcer patients with PAD.3 This was about 4.5 times the $7,200 cost of treating diabetic foot ulcer patients without PAD, according to the SAGE Group.

Increasing Foot Screenings To Avoid ‘The Amputation Lottery’

A recent report in Drug and Therapeutics Bulletin examined the impact of foot screenings in patients with diabetes in England.4 In 1989, a five-year goal was established there to reduce the amputation rates related to diabetes by one half. Instead, cases of Type 2 diabetes and amputations have increased.

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