DIABETES MELLITUS FOOT
SYNDROME
DR OTUKOYA AO.
SR ENDOCRINOLOGY AND METABOLISM UNIT
Outline
Introduction
 Epidemiology

INTRODUCTION
 Definition
The foot of a diabetic patient
 with ulceration, infection and/or
destruction of the deep tissues,
 associated with neurological abnormalities
 and various degrees of peripheral vascular
disease in the lower limb.
(WHO/International Working Group on the
Diabetic Foot)

INTRODUCTION
Africa is experiencing a rapid epidemiological
transition with the burden of noncommunicable diseases esp. diabetes that
will overwhelm the health care systems
which is already overburdened by HIV/AIDS,
TB and Malaria.
This is due to
 Rapid urbanization and westernization of
lifestyle
 Rapidly decreasing physical activity
 Changes in dietary habits
 Ageing of the population
INTRODUCTION
“So how many people with diabetes are there?”
Here are recent estimates of the disease burden due to diabetes and
projections for the future.
2003
2025
Europe
Africa
Europe
Africa
872 million
667 million
863 million
1107 million
621 million
295 million
646 million
541 million
48.4 million
7.1 million
65 million
19million
7.8 %
2.4 %
7.8 %
4.3 %
Population
• Total
• Adult
(20-79 yrs)
Diabetes
• No. of people
(20-79 yrs)
• Prevalence
(20-79 yrs)
Source: International Diabetes Federation and The international Working Group on Diabetes joint
publication 2006.
EPIDEMIOLOGY
In 2013, the global prevalence of diabetes
was estimated at 382 million (20-70yrs) of
which 80% live in low and middle income
countries.
This figure is predicted globally to reach
592 million ( 55% increase) by 2035.
EPIDEMIOLOGY

In Africa, total number of diabetes was
19.8 million in 2013 and will increase to
41.4 million by 2035.
EPIDEMIOLOGY

Diabetes foot accounts for 19.5 to 24% of
all DM mortality.

Diabetes mellitus foot is the second
leading cause of DM related death in
Nigeria.
EPIDEMIOLOGY

40% - 60% of all non traumatic lower limb
amputation

85% of diabetic related foot amputation are
preceded by foot ulcer

4 out of 5 ulcer in diabetics are precipitated
by trauma

4% -10% is the prevalence of foot ulcer in
diabetics
EPIDEMIOLOGY
IN a study done in Zaria by ZAKARI et al in
2003
• 142 DM patients were admitted over a 12
months period.
• 31% had DM foot.
• 61% were male and 39% female.
• Right foot affected in 48%
• 43% presented with Wagner's grade 4
• 11% had amputation
• 7% died during hospitalization.
•
EPIDEMIOLOGY
 LUTH AND LASUTH
 DMFS typical in age 50-60
years

80-90% are not registered patients

Case fatality is 28%

Hospital stay between 30-90 days

Cost of treatment between 50,000 to
2,000,000 naira only.
EPIDEMIOLOGY
LUTH STATISTICS (2015)
 A&E
 Feb till date: 26 pts. M:F ; 1:1.2
 40-82 yrs . Mean : 58yrs
 4 died in A&E : 15.4% Mortality
 All with foot gangrene
 Ward
 5 pts. 5.7% of ward admission
 M:F : 1:1.5

EPIDEMIOLOGY

Amputations

Up to 20% undergo an ipsilateral amputation
within 12 months

Up to 50% undergo a contralateral
amputation within 1-3 years; >50% within 5
years

3 year mortality after amputation is 20-50%
EPIDEMIOLOGY
(OF AMPUTATION)

25-50 % of diabetic foot infections lead to
minor amputations

10-40 % require major amputations

10-30 % of patients with a diabetic foot
ulcer will go on to amputation
EPIDEMIOLOGY
(OF AMPUTATION)

1 in 4 of diabetes patient with DM foot
require immediate amputation and five
years recurrence rates of ulcer is 70%.
ANATOMICAL DISTRIBUTION
~50% of ulcers are on the toes
 ~30-40% are on the plantar metatarsal
head
 ~10-15% are on the dorsum of the foot
 ~5-10% are on the ankle
 up to 10% are multiple ulcers

EPIDEMIOLOGY

Cellulitis occurs 9 times more frequently
in diabetics than non-diabetics

Osteomyelitis of the foot 12 times more
frequently in diabetics than non-diabetics

Foot ulcerations and infections are the
most common reason for patients with
diabetes to be admitted to the hospital
COST

Cost of diabetic foot management is 12-15%
of the total healthcare budget for diabetes in
developed countries.

May as high as 40% in developing countries.

These figures do not account for cost of loss
of potential working members to the
economy and social costs of the inability to
support a family.
EPIDEMIOLOGY
85% of all diabetic foot related problems
are preventable
 Every 20 seconds a limb is lost due to
diabetes somewhere in the world

SUMMARY

In summary I have presented the
definition introduction and epidemiology
of DMFS.
Footwear - socks
REFRENCES
Ogbera A.O Fasanmade O.A. The foot at
risk in nigerians with diabetes. The
nigerian scenario. Int Jendo
metab2005;4:165-73
 Int working group on DM foot 1999.
international consensus on the diabetic
foot. The Netherlands. Pp 22-96.
