What Studies Reveal About The Preventive Value Of Podiatric Care For Patients With Diabetes

Paul J. Liswood, DPM, FACFAS

The care podiatrists provide for patients with diabetes is essential, improves outcomes and saves money. That is the value we provide. Now we have data that demonstrates this value. Last year, two independent studies, one by Carls and colleagues and the other by researchers at Duke University, confirmed this truth.1,2

   As we embark on new healthcare delivery models and healthcare reform, this value will prove very important. The government and private insurance payers are looking to improve patient outcomes and lower healthcare costs. One of the most expensive, devastating and prevalent diseases is diabetes.

   Almost 24 million people have diabetes in the United States, incurring healthcare costs estimated at $174 billion annually.3 Foot ulcers and amputations were estimated to have cost the U.S. healthcare system $29 billion in 2007.4 Up to 25 percent of patients with diabetes will develop a foot ulcer during their lifetime.5 Researchers have reported costs for treating foot ulcers ranging between $7,439 and $20,622 per episode.6 Direct costs of major limb amputations — which are preceded by a foot ulcer 85 percent of the time — may be as high as $70,434.6 The lifetime costs of an amputation can be substantially higher than that. The annual incidence of lower extremity amputation is 5 to 8 per 1,000 patients with diabetes and the annual incidence of foot ulcerations in patients with diabetes is somewhere between 2 and 6.8 percent.6

   The high morbidity and mortality associated with foot ulcerations and amputations are well known. People with a history of a diabetic foot ulcer have a 40 percent greater 10-year mortality than people with diabetes alone, according to a study by Iversen and colleagues in 2009.7 Following a lower extremity amputation, up to 68 percent of patients will lose the contralateral limb within five years. The mortality rate following amputation is up to 50 percent between three and five years after an amputation. This poor prognosis is worse than that of many malignancies.5 (See “Comparing Five-Year Mortality Rates Of Amputation And Various Cancers” above at left.)

   Does the care provided by podiatrists improve the health of patients with diabetes and reduce healthcare costs? That is the question researchers asked in the study, “The Economic Value of Specialized Lower-Extremity Medical Care by Podiatric Physicians in the Treatment of Diabetic Foot Ulcers.”1

   Study researchers examined approximately half a million medical claims from patients with commercial insurance and patients with Medicare. The study focused on those patients who developed foot ulceration. Researchers subsequently made a comparison by looking at the year preceding ulceration to see if the patient saw a podiatrist, and examined outcomes and economic costs.1

   The results were compelling. Commercial insurance patients who saw podiatrists had a 28.8 percent lower risk of amputation and a 24.4 percent lower risk of hospitalization. Medicare patients had a 22.5 percent lower risk of amputation and a 13.7 percent lower risk of hospitalization if they were under the care of a podiatrist.1 (See “Do Podiatry Visits Reduce Hospitalization And Amputation In Patients With Diabetes?” at right.)

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