DIABETES MELLITUS FOOT SYNDROME DR OTUKOYA AO. SR ENDOCRINOLOGY AND METABOLISM UNIT

Outline Introduction Epidemiology

INTRODUCTION  Definition The foot of a diabetic patient with ulceration, infection and/or destruction of the deep tissues, associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb. (WHO/International Working Group on the Diabetic Foot)

INTRODUCTION Africa is experiencing a rapid epidemiological transition with the burden of non- communicable diseases esp. diabetes that will overwhelm the health care systems which is already overburdened by HIV/AIDS, TB and Malaria. This is due to Rapid urbanization and westernization of lifestyle Rapidly decreasing physical activity Changes in dietary habits Ageing of the population

INTRODUCTION “So how many people with diabetes are there?” Here are recent estimates of the disease burden due to diabetes and projections for the future EuropeAfricaEuropeAfrica Population Total Adult (20-79 yrs) 872 million 621 million 667 million 295 million 863 million 646 million 1107 million 541 million Diabetes No. of people (20-79 yrs) Prevalence (20-79 yrs) 48.4 million 7.8 % 7.1 million 2.4 % 65 million 7.8 % 19million 4.3 % Source: International Diabetes Federation and The international Working Group on Diabetes joint publication 2006.

EPIDEMIOLOGY In 2013, the global prevalence of diabetes was estimated at 382 million (20-70yrs) of which 80% live in low and middle income countries. This figure is predicted globally to reach 592 million ( 55% increase) by 2035.

EPIDEMIOLOGY In Africa, total number of diabetes was 19.8 million in 2013 and will increase to 41.4 million by 2035.

EPIDEMIOLOGY Diabetes foot accounts for 19.5 to 24% of all DM mortality. Diabetes mellitus foot is the second leading cause of DM related death in Nigeria.

EPIDEMIOLOGY 40% - 60% of all non traumatic lower limb amputation 85% of diabetic related foot amputation are preceded by foot ulcer 4 out of 5 ulcer in diabetics are precipitated by trauma 4% -10% is the prevalence of foot ulcer in diabetics

EPIDEMIOLOGY IN a study done in Zaria by ZAKARI et al in DM patients were admitted over a 12 months period. 31% had DM foot. 61% were male and 39% female. Right foot affected in 48% 43% presented with Wagner's grade 4 11% had amputation 7% died during hospitalization.

EPIDEMIOLOGY  LUTH AND LASUTH DMFS typical in age years 80-90% are not registered patients Case fatality is 28% Hospital stay between days Cost of treatment between 50,000 to 2,000,000 naira only.

EPIDEMIOLOGY LUTH STATISTICS (2015)  A&E  Feb till date: 26 pts. M:F ; 1:1.2  yrs. Mean : 58yrs  4 died in A&E : 15.4% Mortality  All with foot gangrene  Ward  5 pts. 5.7% of ward admission  M:F : 1:1.5

EPIDEMIOLOGY Amputations Up to 20% undergo an ipsilateral amputation within 12 months Up to 50% undergo a contralateral amputation within 1-3 years; >50% within 5 years 3 year mortality after amputation is 20-50%

EPIDEMIOLOGY (OF AMPUTATION) % of diabetic foot infections lead to minor amputations % require major amputations % of patients with a diabetic foot ulcer will go on to amputation

EPIDEMIOLOGY (OF AMPUTATION) 1 in 4 of diabetes patient with DM foot require immediate amputation and five years recurrence rates of ulcer is 70%.

ANATOMICAL DISTRIBUTION ~50% of ulcers are on the toes ~30-40% are on the plantar metatarsal head ~10-15% are on the dorsum of the foot ~5-10% are on the ankle up to 10% are multiple ulcers

EPIDEMIOLOGY Cellulitis occurs 9 times more frequently in diabetics than non-diabetics Osteomyelitis of the foot 12 times more frequently in diabetics than non-diabetics Foot ulcerations and infections are the most common reason for patients with diabetes to be admitted to the hospital

COST Cost of diabetic foot management is 12-15% of the total healthcare budget for diabetes in developed countries. May as high as 40% in developing countries. These figures do not account for cost of loss of potential working members to the economy and social costs of the inability to support a family.

EPIDEMIOLOGY 85% of all diabetic foot related problems are preventable Every 20 seconds a limb is lost due to diabetes somewhere in the world

SUMMARY In summary I have presented the definition introduction and epidemiology of DMFS.

Footwear - socks

REFRENCES Ogbera A.O Fasanmade O.A. The foot at risk in nigerians with diabetes. The nigerian scenario. Int Jendo metab2005;4: Int working group on DM foot international consensus on the diabetic foot. The Netherlands. Pp