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1362574246 economic burden diabetic foot l 2a

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economic burden diabetic foot l 2a

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1362574246 economic burden diabetic foot l 2a

  1. 1. Economic Burden of Diabetic Foot Dr Sanjeev Kelkar Head, Project Management Group Secretary DFSI October 2007 MSD Training Program Information of this presentation courtesy Dr Anil Kapur of WDF Denmark
  2. 2. Economic Burden of Diabetic Foot Even those patients with diabetes having ready access to health care and are provided with education on foot care, 9% develop foot infections in a two year follow up, (Lavery LA, et al, Risk factors for foot infections in persons with diabetes mellitus, Diabetes Care, 2006,; 29:1288-93) This is an English study
  3. 3. Temporal Prevalence in Urban South India 5.0 8.2 11.6 14.2 R 2 = 0.9971 0 2 4 6 8 10 12 14 16 18 20 1988 1992 1996 2000 Kudremukh Chennai Chennai Chennai Bangalore Hyderabad Ramachandran A et al
  4. 4. Diabetes Mellitus- Genetics Risk of Diabetes - F/H/O Diabetes - One parent diabetic - One parent diabetic and other from a diabetic family Family History 20 % 40 % 70 % V Mohan & KGMM AlbertiV Mohan & KGMM Alberti International Textbook of Diabetes Mellitus,1992,178.International Textbook of Diabetes Mellitus,1992,178. • Family history significant predictor of Diabetes
  5. 5. Presenting Symptoms Symptoms All Type 1 Type 2 Tiredness / Fatigue 50.7% 46.5% 51.0% Excess Urination 43.3% 59.2% 42.4% Excess Thirst/Hunger 38.2 % 52.1% 37.4% Weight Loss 19.7% 34.4% 18.9% Nausea/ Abdom. Pain 18.0% 17.8% 16.5% Non Healing Wound 7.4% 7.4% 7.4% Others 2.1% 2.1% 2.1% Skin Infection 1.9% 3.2% 1.8% Heart Problems 1.3% 0.7% 1.3% Loss of Sensation 0.4% 0.4% 0.4% CODI Study
  6. 6. Test All Type 1 Type 2 Urine 93.8% 97.9% 93.6% FBS 91.8% 94.7% 91.6% PPBS 93.2% 96.1% 93.0% OGTT 17.9% 19.1% 17.8% GHb 7.6% 18.4% 7.0% Serum Lipids 7.4% 9.9% 7.3% Kidney Function 11.1% 17.4% 10.8% X-rays 16.8% 24.5% 16.4% ECG 25.5% 38.3% 24.8% Others 3.3% 4.3% 3.3% BP Measurement 54.3% 51.8% 54.4% Foot Examination 7.5% 11.7% 7.2% Eye Examination 35.1% 37.6% 35.0% Lab Tests / Clinical Examination Since Diagnosis CODI Study
  7. 7. Late Complications 39% 31% 7% 3% 1% Types of Complications Foot Eye MI Stroke ESRD Number of Complications 46% 30% 10% 14% Nil One Two Three+ Does Not Include •Hypertension (27%) •Proteinuria (8%) •Elevated Creatinine (4%) •Lipid Abnormalities (54%)
  8. 8. CODE 2: Effect of complications on per patient costs 0 1 2 3 4 Costimpactfactor None Microvascular Macrovascular Both Without complications With complications 1.7 X 2.0 X 3.5 X Lucioni C et al. PharmacoEconomics- Italian Research Articles, 2000 2(1):1-21 None Microvascular Macrovascular Both
  9. 9. Effect Of Patient Education On Amputation Rates Knee & Above 12% 15% 5% 46% 35% 60% Toe & Metatarsal Below Knee No Education Education University Hospital of Geneva 1979-1989. All comparisons p<0.001. Assal JP et al. Diabete Metab 1993.
  10. 10. CODI Study / AKap/ NNEF ORG Centre for Social Research Hospitalization Rate Complication Specific CODI Study / AKap/ NNEF ORG Centre for Social Research Total Mean Duration of Hospitalization Cause Specific
  11. 11. CODI Study / AKap/ NNEF ORG Centre for Social Research Total Mean Hospitalization Cost Cause Specific
  12. 12. CODI Study / AKap/ NNEF ORG Centre for Social Research Productivity Loss Problems at Work
  13. 13. Classification of Diabetic foot Wounds  Several available – none universally acceptable  Wagner – Meggitt six grade classification by depth of the ulcer and extent of gangrene  The University of Texas Classification grades wounds by the ulcer depth and then stages by presence of infection and ischemia
  14. 14. Classification of Diabetic foot Wounds  S(AD) grades wound in five categories depending upon the size which includes area and depth, in addition to the presence of sepsis, arteriopathy, and denervation  PEDIS by the International working group on the Diabetic Foot – grading on Perfusion, Extent, Depth, Infection and Sensation
  15. 15. Classification of Diabetic foot Wounds  The Infectious Diseases Society of America  Subdivides infected diabetic foot wounds in mild ie restricted involvement of skin and subcutaneous tissue moderate ie, more extensive or affecting deeper tissues severe ie,accompanied by systemic signs of infection or metabolic instability
  16. 16. Classification of Diabetic foot Wounds  Mike Edmonds – Ali Foster  Normal Foot  High risk foot  Ulcerated foot  Infected foot  Ischemic foot  Gangrenous foot
  17. 17. Classification of Diabetic foot Wounds  The purpose is as for all classifications  To be able to describe as closely as possible, to analyse such hopefully accurate descriptions of wounds in comparing results  Overlaps notwithstanding comparisons across studies may be difficult

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