Etiology
Age distribution for diabetic ulcers
Epidemiology
Prevalence of diabetic ulcers by race
According to the National Institute of Diabetes and Digestive and Kidney Diseases, an estimated 16 million Americans are known to have diabetes, and millions more are considered to be at risk for developing the disease. Diabetic foot lesions are responsible for more hospitalizations than any other complication of diabetes. Among patients with diabetes, 15% develop a foot ulcer, and 12-24% of individuals with a foot ulcer require amputation. Indeed, diabetes is the leading cause of nontraumatic lower extremity amputations in the United States. In fact, every year approximately 5% of diabetics develop foot ulcers and 1% require amputation.
Diabetes occurs in 3-6% of Americans. Of these, 10% have type 1 diabetes and are usually diagnosed when they are younger than 40 years. Among Medicare-aged adults, the prevalence of diabetes is about 10% (of these, 90% have type 2 diabetes). Diabetic neuropathy tends to occur about 10 years after the onset of diabetes, and, therefore, diabetic foot deformity and ulceration occur sometime thereafter.
The etiologies of diabetic ulceration include neuropathy, arterial disease, pressure, and foot deformity. Diabetic peripheral neuropathy, present in 60% of diabetic persons and 80% of diabetic persons with foot ulcers, confers the greatest risk of foot ulceration; microvascular disease and suboptimal glycemic control contribute.
The issue of diabetic foot disease is of particular concern in the Latino communities of the Eastern United States, in African Americans, and in Native Americans, who tend to have the highest prevalence of diabetes in the world.
