Epidemiology of diabetic foot problems

Since diabetes mellitus is growing at epidemic proportions worldwide, the prevalence of diabetes-related complications is bound to increase. Diabetic foot disorders, a major source of disability and morbidity, are a significant burden for the community and a true public health problem. Many epidemiological data have been published on the diabetic foot but they are difficult to interpret because of variability in the methodology and in the definitions used in these studies. Moreover, there is a lack of consistency in population characteristics (ethnicity, social level, accessibility to care) and how results are expressed. In westernized countries, two of 100 diabetic patients are estimated to suffer from a foot ulcer every year. Amputation rates vary considerably: incidence ranges from 1% in teh Madrid area and in Japan to up to 20% in some Indian tribes in North America. In metropolitan France, the incidence of lower-limb amputation is approximately 2% but with marked regional differences, and in French oversear territories, the incidence rate is much higher. Neverthless, the risk for ulceration and amputation is much higher in diabeties compared to the nondiabetic population: the lifetime risk of a diabetic individual developing an ulcer is as high as 25% and it is estimated that every 30s an amputation is performed for a diabetic somewhere in the world risk. Age and sex as well as social and cultural status are contributing factors. Knowing these factors is essential to classify every diabetic using a risk grading system and to take preventive measures accordingly. (C) 2008 Elsevier Masson SAS. Tous droits reserves.