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New study shines large light on huge numbers in hospital with diabetic foot disease

A new paper from DFA’s Pete Lazzarini and colleagues has completed the trilogy of papers from the Foot Disease in Inpatients Study investigating the burden of foot disease in inpatient populations.

This new Journal of Diabetes Research paper reports 46% of all people in our hospitals have a foot complication (peripheral arterial disease, peripheral neuropathy, foot deformity), 24% have multiple and 11% have had previous foot disease (foot ulcer, amputation). In all people with diabetes in our hospitals, it finds 66% have a foot complication, 39% multiple and 22% previous foot disease.

We have already discussed the earlier two papers of this large study in detail. So we won’t go into the study’s methodology again except to say this large multi-site Australian study is arguably the most robust and generalizable study ever on the burden of foot disease in our hospitals.

However, as we are perhaps a little biased, as always we encourage you to make up your own minds and read our previous summaries and the full texts from the first and second papers yourself.

What we will focus on in this summary is using the combined findings from these papers and thesis to answer the burning questions on the number of people in our hospitals with diabetic foot disease.

1. How many people are hospitalised because of diabetic foot disease?

This study found that on average 2% (1 in every 50) of all people in our hospitals each night have been admitted for the primary reason of diabetic foot disease (ulcers, infections or ischaemia).  Alarmingly in the subgroup of inpatients with diabetes, they found that 9% (1 in 11) of all people with diabetes in our hospitals have been admitted for the primary reason of diabetic foot disease.

2. How does diabetic foot disease compare to other causes of hospitalisations in Australia?

The authors were able to cleverly calculate from their findings that 27,600 public hospital admissions each year (including 360,000 occupied hospital bed days) were caused by DFD in Australia.  They found that diabetic foot disease was in the top 20 causes of all Australian hospitalisations when they compared these numbers to the numbers reported for all causes of hospitalisation in Australia (~13th in front of other top 20 causes, such as atrial fibrillation, inguinal hernia and knee replacements).

3. How many people in our hospitals have diabetic foot disease?

The study found that 4.5% (1 in 22) of all people in our hospitals have active diabetic foot disease that needs treatment while they are in hospital.  The authors also report that 1.4% (30% of those with active diabetic foot disease) had an amputation procedure during their current hospitalisation. In the subgroup of inpatients with diabetes, they found 19% (1 in 5) of all people with diabetes in our hospitals have active diabetic foot disease and 6% (30% of those with active diabetic foot disease) had an amputation procedure during their current hospitalisation.

4. How many people in hospitals are at-risk of developing diabetic foot disease?

The study found that 15% (1 in 6) of all people in our hospitals have risk factors for diabetic foot disease (previous foot disease, previous amputations, peripheral arterial disease, peripheral neuropathy or moderate foot deformity). In the subgroup with diabetes, they found 66% (2 in 3) of all people with diabetes in our hospital were at-risk for developing diabetic foot disease.

5. Finally, what does this mean for an average 600-bed Australian hospital?

The authors nicely contextualised these findings, by stating that ‘in an average 600-bed Australian hospital on any given day one can expect their hospital will contain:

  • 12 inpatients admitted because of diabetic foot disease,
  • 15 more inpatients with diabetic foot disease that also need foot treatment,
  • 65 more inpatients that have major risk factors for developing diabetic foot disease,
  • 92 inpatients in total will have, or be at-risk of, diabetic foot disease, &
  • 9 of these inpatients will undergo an amputation procedure’.

They also point out that diabetic foot disease makes up less than half of the overall numbers of inpatients with, or at-risk of, foot disease in our hospitals. This perhaps means diabetic foot disease is just the start of the foot disease in inpatients story … but we’ll leave that for another summary.

In conclusion, this is an important study demonstrating clearly and robustly the burden that diabetic foot disease imposes on hospitals in the Australian population.  The authors also report their findings to be generalizable to other developed nations across the world after comparing their findings with other international studies. With World Diabetes Day fast approaching this year these findings suggest that the world should focus more of its diabetes attention down under on its feet.

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