Diabetic Foot Care: Financial Implications and Practice Guidelines

Foot problems are common in the 12 million diagnosed and undiagnosed United States diabetic subjects, and result in extensive hospitalization, disfiguring surgery, lifetime disability, and a diminished quality of life. The unequivocal nature of a lower-extremity amputation makes this the best-defined and monitored of the diabetic foot problems. United States hospital discharge data from 1980 to 1987 indicated that amputation rates increased with advancing age, and were higher in blacks than whites, and men than women. Foot pathology has been reported as the most common complication of diabetes leading to hospitalization. Economic considerations extend beyond direct cost estimates based on numbers of affected individuals, and the cost and duration of patient care. Indirect cost estimates describing lost economic productivity because of related illness, disability, and premature death are needed. Multidisciplinary team approaches to diabetic foot care have reported statistically significant pre-post program reductions in morbidity and cost. Regardless of the care setting and the availability of foot care teams, diabetic foot care guidelines should be viewed by providers as recommended minimum practice levels to be adapted according to the patient's pathology, comorbidity, and abilities. Although guidelines specify minimum acceptable practice levels, they are not intended to set a ceiling on professional excellence.