Majority of Americans with diabetic foot ulcer suffer from PAD

A new analysis published by THE SAGE GROUP, concludes that peripheral artery disease (PAD) afflicts 2.0-3.7 million U.S. citizens with diabetic foot ulcers (DFU). Approximately 1 million diabetic foot ulcer patients suffer from the most severe and deadly form of PAD, critical limb ischemia.

“Unfortunately, by 2030 these numbers could approach 7.0 million, which implies an even greater economic burden”

"The presence of PAD is very important because PAD increases the risk of developing foot ulcers and once ulcers develop is associated with more adverse outcomes," stated Mary L. Yost, author of the report. "Diabetic foot ulcers accompanied by PAD are more likely to become infected, have a lower probability of healing, longer healing times, are more likely to recur. Furthermore, there is greater risk of major amputations and higher mortality," she elaborated.

"Diabetic foot ulcer patients with PAD are significantly more expensive to treat," Ms. Yost continued. "In 2009 dollars treatment costs per episode were over $32,000 for foot ulcer patients with PAD. This was about 4.5 times the $7,200 cost of treating diabetic foot ulcer patients without PAD," explained Yost. (Treatment costs are based on the Stockl and group analysis of 2000-2001 claims data in a large managed care organization.)

According to the International Working Group on Diabetic Foot (IWDGF) a diabetic foot ulcer is a full-thickness wound, penetrating through the dermis (the deep vascular inner layer of the skin), located below the ankle in a diabetic patient.

Diabetic foot ulcers and the resulting lower extremity amputations are a frequent, disabling and costly complication of diabetes.

"Our population-based analysis concludes that there are currently 3.9-4.6 million U.S. diabetics with foot ulcers representing annual treatment costs of $70-80 billion," Yost stated. "Unfortunately, by 2030 these numbers could approach 7.0 million, which implies an even greater economic burden," she continued.

Commenting on ischemia as a cause of diabetic foot ulcers, Yost said, "To our surprise ischemia has only recently become recognized as a significant cause of DFU. Research on critical limb ischemia and diabetic foot remains relatively unexplored, which is unfortunate because the severity of ischemia increases the risks of adverse outcomes, specifically non-healing ulcers, amputation and mortality," she elaborated.

"Ischemic ulcers are more costly to treat, primarily due to a greater number of hospitalizations," Ms. Yost stated. "More of these do not heal and there is a higher rate of amputation; patients are older and have a higher prevalence of severe comorbidities," continued Yost.

"As a result of our analysis, we agree with the Eurodiale (European Study Group on Diabetes and the Lower Extremity) authors that diabetic foot ulcers are a different disease in individuals with PAD," Yost concluded.