Part 6: Detection and Prevention of Foot Problems in Type 2 Diabetes

Background - Economic considerationsDiabetic foot problems are a major cost to the health care system. The most commonreason for hospital admission for diabetes is a diabetic foot complication (Young et al,1993a). The DiabCost Australia study (Colagiuri et al, 2003) showed thathospitalisation and complications were the major cost drivers in people with Type 2diabetes.People with diabetes are 3-7 fold more likely to have an amputation than thosewithout diabetes (Reiber, 1993). About half of the lower extremity amputations are“major” (below or above knee), while the other half involving the foot or toes aredesignated “minor”. The direct cost of an amputation in the UK in 1996 was $A27,600 for a major amputation and $A 6,900 for a minor amputation (Connor, 1997)and are estimated to be similar in Australia. In Australia there are at least 2600diabetes-related lower limb amputations each year (Payne, 2000). Applying thesecosts to the 2600 amputations which are performed each year in Australia gives a totaldirect cost of approximately $A 44 million each year. A 50% reduction in LEA wouldresult in an annual saving of $A 22 million. However, there is little evidence tosupport a reduction and the trend may be in the other direction. For example, during1992 to 1997, hospital separations in Central Australia for diabetes foot problemsincreased 3-fold (Eward et al, 2001).Evidence - Economic considerationsFoot problems in people with diabetes are costlyGirod et al (2003) evaluated the cost of foot ulcers in people with diabetes. Among239 subjects (mean age 65.5 years, 72.8% with Type 2 diabetes), 79.5% hadneuropathy, and 59% had previously suffered from one or more foot ulcers and 38.5%had already had an amputatation. At the time of inclusion in this study, patient’s mainlesion had been present for an average of 13.5 months. Lesions were most commonlyfound on the toes (50.5%) or the sole of the foot (24.3%). Lesions were consideredsevere in 28% of subjects - grade 3, 4 or 5 according to the Wagner classification atthe study inclusion consultation. The average monthly costs related to the treatment offoot ulcers per person were $A 1190 for outpatient care and $A 2660 forhospitalisation. The grade of the lesion was a significant cost determinant of bothoutpatient (p=0.0403) and hospital care (p=0.0001). The average monthly cost for apatient with a grade 4/5 lesion was 2.5 times higher than for a grade 1 lesion ($A 4690v $A 1925).An Australia study also found a considerable difference between hospital andoutpatient costs of treating foot ulcers. The average cost of hospitalisation fortreatment of a diabetic foot ulcer was $A 12,474 in 1994. By comparison outpatienttreatment by a specialist foot care team dthis cost by 85% (Hoskins, 1994).In a study by Benotmane et al (2001), 163 out of 1,779 hospital admissions fordiabetes were related to a foot lesion during a 5-year period. The lesions wereallocated to one of the following groups: I - superficial or deep ulcer; II - deep abscess91