THE BURDEN OF DIABETIC FOOT ULCERS

Lower extremity ulcers represent a major concern for patients with dia betes and for those who treat them, from both a quality of life and an economic standpoint. Studies to evaluate quality of life have shown t hat patients with foot ulcers have decreased physical, emotional, and social function. Analyses of economic impact have shown (1) the majori ty of costs occur in the inpatient setting, (2) a lack of financial be nefit when comparing primary amputation with an aggressive approach to limb salvaging including vascular reconstruction, and (3) private ins urance provides greater reimbursement for inpatient care than does Med icare. Results of etiologic studies suggest that hyperglycemia induces diabetes-related complications through sorbitol accumulation and prot ein glycation, and the resultant nerve damage manifests as peripheral neuropathy, which predisposes to ulcer development. Patients with diab etes also have an increased incidence of peripheral vascular disease, impaired wound healing, and decreased ability to fight infection. In l ight of these factors, it is sometimes difficult to determine the opti mal course for patient management. This review is aimed at helping hea lthcare providers make better decisions about treatment, resource use, and strategies for future foot ulcer prevention. Am J Suug. 1998;176( Suppl 2A):5S-10S. (C) 1998 by Excerpta Medica, Inc.