This, from the International Society on the Diabetic Foot in the Hague
What happens when nearly 2 million people with diabetic foot ulcers walk into outpatient clinics?
Grant Skrepnek, Joseph Mills, David Armstrong, The University of Arizona; Southern Arizona Limb Salvage Alliance, Tucson, AZ, United States
Aim: To evaluate ambulatory clinical cases of diabetic foot ulcers (DFUs) in the U.S. from 2006-2010 and assess outcomes of emergency department referral or inpatient (ED/IP) admission, number of clinic visits per year, and physician time spent per visit.
Methods: This cross-sectional study utilized the nationally-representative Centers for Disease Control (CDC) National Ambulatory Medical Care Survey (NAMCS) data from 2006- 2010 to include all clinic-based office visits in the U.S. among persons ≥18 years of age with a diagnosis of diabetes. Generalized linear models (binomial/logistic, negative binomial, zero-truncated negative binomial) were used to assess the odds or incidence rates of ED/IP admission, past number of annual visits, and physician time spent per case among those involving DFUs, also controlling for age, sex, race, regional poverty and education level, rural residence, geographic area, primary payer, chronic comorbid diseases, and year.
Results: Across the estimated 539.9 million ambulatory care cases involving diabetes presenting from 2006-2010 in the U.S., 1.9 million had a DFU (0.4%), averaging 66.9±14.5 years of age, 64.5% male, 81.4% white, and 28.7% rural. Multivariable analyses indicated DFUs were associated with an adjusted odds or incidence rate ratio of 4.6x higher risk for ED/IP admission, 76.0% more annual clinic visits, and 53.0% longer physician time per visit (p<0.05 for all); these were higher than a majority of comorbid diseases measured and similar to or exceeding cancer, heart failure, or renal failure., Across DFU cases alone, those residing in more impoverished areas had a 62.0% shorter physician visit time (p<0.05), though no difference in the number of visits per year.
Conclusion: This investigation of 1.9 million ambulatory cases of DFUs in the U.S. indicates markedly greater odds for emergency department referral or hospital admission, annual number of outpatient visits, and physician time spent per visit., Outcomes relating to DFUs exceeded or were similar to those of cancer, heart failure, or renal failure. Funding: This research was not funded by any agency or organization.