Diabetic Foot

Abstract

Diabetes has exhibited a fast growth as a public health challenge and a budding epidemic across low-and-middle-income countries like India.1 It was projected that the overall prevalence of diabetes will increase from 9.3% (463 million) in 2019 to 10.2% (578 million) by 2030 and 10.9% (700 million) by 2045.2 According to an estimate, India will hold 69.9 million diabetics by 2025 with still huge numbers yet to be diagnosed.1,3 The long duration of diabetes carries the risk of developing multiple complications, among which foot ulceration (DFU) or the 'diabetic foot is a major complication.4 Diabetes for a decade is considered a significant duration to develop a DFU.5 However, the disease's course- as poor/well-controlled- will change the outcome. 6 DFU is an aftereffect of combined neuro-vascular compromise in the wake of some trivial trauma and poor glycaemic control.4 It can impair the quality of life, affect social participation, and interferes with livelihood.7 Also economic burdens of diabetic extremity care are as high as cancer.8

Studies have indicated that diabetic patients have a 25% lifetime risk of developing a foot ulcer.9 About 6% of people with diabetes suffer from DFU, ranging from infection, ulceration, destruction of tissues, or gangrene.10 The global incidence of diabetic foot ulcers is nearly 3%, with the reported incidence in developed nations like the U.S. and the U.K. as high as 10%.11 Major issue in DFU is that an ulcer has an increased risk of progression that may ultimately result in amputation; an ulcer is seen as a predecessor in up to 85% of amputations.11 It is estimated that 0.03% to 1.5% of DFUs eventually require amputation, resulting in significant disability and an increased mortality rate.12,13 Perhaps, most ulcers can be prevented with good foot care and screening for risk factors.9 At least 40% of amputations in diabetic patients can be avoided with a team approach to wound care.14 In low- and middle-income countries like ours, barefoot walking, lack of awareness, delay in seeking medical care, and shortage of trained healthcare providers and foot care services are common factors that add to the burden of foot disease. 15