Diabetic Foot: Facts and Figures

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Diabetes affects 37 million people in the US and more than 550 million people worldwide.

Diabetesatlas.org/American Diabetes Association

Diabetic Foot Ulcers (DFUs) affect 18.6 million people, worldwide and 1.6 million each year in the USA

Armstrong, Tan, Boulton, and Bus, JAMA, 2023

The big picture: Diabetes, Diabetic Foot Ulcers, Peripheral Artery Disease and Limb Loss Visualized

The top 10 diabetes nations 
International Diabetes Federation / Diabetesatlas.org

Worldwide trends in diabetes from 1980 to today

Diabetes kills more people annually than breast cancer and HIV/AIDS combined.

Two thirds of all new cases of type 2 diabetes are diagnosed in low- and middle-income countries, such as Mexico, India, China and Egypt.

Pharmacoeconomics, 2015

Diabetes reduces a woman’s chances of employment by 50%

Pharmacoeconomics, 2015

If diabetes were a country, it would be the 3rd largest in the world

International Diabetes Federation / Diabetesatlas.org

80% of people with diabetes are from low and middle income nations

International Diabetes Federation, 2012

The number of people with diabetes is increasing in every single nation

International Diabetes Federation/World Health Org 2012

Half of people with diabetes don’t know they have it.

American Diabetes Association / International Diabetes Federation, 2012

Quiet. Slow. Deadly. Expensive: Chronic Diseases Account for 75% of our Healthcare Costs.


25% of all medical care is consumed by 1% of the population and nearly 50% is consumed by 5%.
AHRQ, 2013


1 Day with #Diabetes in USA:  5000 diagnosed, $670M, 280 lives, 200 limbs. We can do better. Today.
American Diabetes Association, 2014

Every 1.2 seconds someone develops a diabetic foot ulcer (DFU).

Armstrong, Boulton, Bus, NEJM, 2017 / Armstrong, Tan, Boulton, Bus, JAMA, 2023

Seconds Count: Every 7 seconds someone dies from diabetes. Every 20 seconds someone is amputated.

International Diabetes Federation / Diabetesatlas.org

Armstrong, et al, Diabetes Care 2013

One million dollars every 30 minutes: the cost of inpatient and outpatient care of the diabetic foot in the USA alone.

Skrepnek, Mills, Armstrong, Diabetes Care, 2015

Armstrong, Boulton, Bus, New England Journal of Medicine, 2017

The cost of diabetic foot ulcers is greater than that of the five most costly forms of cancer

Barshes, et al, Diab Foot Ankle 2013

The cost to heal a complex diabetic foot ulcer is between 3 months and 6 years’ salary depending on nationality

Cavanagh, et al, Diabetes Metab Res Rev, 2012

Diabetic Foot Ulcer patients are twice as costly to US Medicare as those with diabetes alone

Rice, et al, Diabetes Care, 2014

Inpatient care constitutes nearly two thirds of insurance costs for diabetic foot ulcers
Rice, et al, Diabetes Care, 2014

The estimated annual US Burden of Diabetic Foot Ulcers is at least $15 Billion
Rice, et al, Diabetes Care, 2014

By 2030, at least 550 million people will have diabetes- approximately 10% of the world’s adult population.

International Diabetes Federation (IWGDF), 2011

There are now approximately 86M people with pre-diabetes in the USA
That’s the total population of 30 states. 
American Diabetes Association, 2014
2010 United States Census

The population of diabetes in the USA is greater than the population of the nation’s 10 largest cities.
American Diabetes Association, 2012
2010 United States Census

Today with Diabetes In America: 200 Lives, 200 Limbs, 86 million at risk.
American Diabetes Association 2014

The population of Diabetes in Arizona (home of SALSA) would make it the fourth largest city in the state.
American Diabetes Association, 2012
2010 United States Census

60-70% of those with diabetes will develop peripheral neuropathy, or lose sensation in their feet.

Dyck et al.  Diabetic Neuropathy 1999

More than 90% of people with diabetic peripheral neuropathy are unaware they have it.

Bongaerts, et al, Diabetes Care, 2013

Up to 34% of those with diabetes will develop a foot ulcer.

Armstrong, Boulton, Bus, New England Journal of Medicine, 2017

The yearly incidence of diabetic foot ulcers ranges from 2% to 32%, depending on ADA risk classification
Boulton, Armstrong, et al, Diabetes Care 2008
Lavery , et al, Diabetes Care  2008
Sibbald, et al, Adv Skin Wound Care, 2012

More than half of all foot ulcers (wounds) will become infected, requiring hospitalization and 20% of infections result in amputation.

Lavery, Armstrong, et al.  Diabetes Care 2006

Diabetes contributes to approximately 80% of the 120,000 nontraumatic amputations performed yearly in the United States.

Armstrong et al. Amer Fam Phys 1998

“Every 20 seconds, somewhere in the world, a limb is lost as a consequence of diabetes”

DFCon11, Bakker (after Boulton), DFCon.com

Boulton, The Lancet (cover), Nov. 2005

After a major amputation, 50% of people will have their other limb amputated within 2 years.

Goldner. Diabetes 1960

Armstrong, et al, J Amer Podiatr Med Assn, 1997

More than half of people with  osteomyelitis of the heel will undergo high level amputation

Faglia, et al, Foot Ankle Int, 2013

The relative 5-year mortality rate after limb amputation is 68%. When compared with cancer – it is second only to lung cancer (86%).  (Colorectal cancer 39%, Breast cancer 23%, Hodgkin’s disease 18%, Prostate cancer 8%)

Armstrong, et al, International Wound Journal, 2007

Median time to healing for diabetic foot wounds: 147,188, and 237 days for toe, midfoot and heel ulcers.

Pickwell, et al, Diabetes Metab Res Rev, 2013

People with a history of a diabetic foot ulcer have a 40% greater 10 year mortality than people with diabetes alone.

Iversen, et al, Diabetes Care, 2009

Every 30 minutes a limb is lost due to a landmine, Every 20 seconds, a limb is lost due to diabetes.

Bharara, Mills, Suresh, Armstrong, Int Wound J, 2009

Having a wound immediately doubles one’s chances of dying at 10 years compared with someone without diabetes

Iversen, et al, Diabetes Care 2009

One third of patients seeking care for ischemic wounds die unhealed
Elgzyri, et al, Eur J Vasc Endovasc Surg, 2013

For people on dialysis receiving an amputation, 2 year mortality is 74%

Ndip, et al, 2012, Diabetes

Diabetic foot ulcers double mortality and heart attack risk while increasing risk for stroke by 40%
Brownrigg, et al, Diabetologia, 2012

Chronic wounds affect some 8 million Americans each year. That’s one wound every 3.8 seconds in the USA, alone.
Harsha , 2008 and Tomic-Canic 2010

Each $1 invested in care by a podiatrist for people with diabetes results in $27 to $51 of healthcare savings.

JAPMA, 101(2), 2011

Podiatry care not only reduces amputation risk, but also dramatically impacts rate of hospitalization and reulceration
Gibson, et al, Int Wound Journal, 2013

Podiatric medical care in people with history of diabetic foot ulcer can reduce high level amputation from between 65% and 80%
Gibson, et al, Int Wound Journal, 2013

Instituting a structured diabetic foot program can yield a 75% reduction in amputation rates and a near four-fold reduction in inpatient mortality
Weck, et al,  Cardiovascular Diabetology, 2013

When footcare is removed from a population with diabetes, there is a 37% increase in hospital admissions for limb threatening wounds and 45% increase in individual patient charges.

Skrepnek, Mills, Armstrong, Diabetes Care, 2014

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