Diabetic foot infection incidence declines 52% in 15-year span
Incidence of diabetic foot infections and consequential lower-extremity amputation in the United States has been significantly reduced from 1996 to 2010, according to recently published data.
“Diabetes can result in impaired pain sensation after injury of the foot, which may consequently allow pathogens to overcome a damaged epidermal barrier and cause infection,” the researchers wrote. “The resulting diabetic foot infection (DFI) is a complex and challenging disease.”
To identify national trends in DFI, Bryson M. Duhon, PharmD, of the School of Pharmacy at the University of Texas, and colleagues conducted a retrospective cohort study examining 1,059,552 DFI discharges. Researchers accessed patient information through the CDC’s National Hospital Discharge Survey, which collects data on patient demographics, admission and payment source, diagnoses, treatments and discharges. Included patients were aged 18 years or older, had a principal discharge diagnosis of foot infection and a secondary diagnosis of diabetes, and were discharged between 1996 and 2010. The primary study outcome was incidence of DFI per 100 diabetes discharges, with other health outcomes such as lower-extremity amputation (LEA) or all-cause mortality also examined.
The patients (median age, 67 years; 58% male; 75% white) lived primarily in the South (39%), and Medicare was the primary source of payment for 61%. Foot infections were most often categorized as gangrene (38.9%), cellulitis-abscesses (20.7%) and ulcers (17.7%).
DFI discharges decreased from 86,563 in 1996 to 77,491 in 2010. DFI incidence per 100 diabetes discharges declined 52% over the study period, which the researchers wrote was primarily driven by an increase in overall diabetes diagnoses. Proportion of DFIs resulting in LEA fell from 33.2% in 1996 to 17.1% in 2010. Independent risk factors for DFI among diabetic patients identified using multivariable regression included peripheral vascular disease, peripheral neuropathy, male sex, discharge from the Midwest region and dialysis.
“These health outcome improvements among diabetics are likely a combination of enhanced efforts to reduce diabetes complications and an increase in the number of diagnosed diabetics in the U.S.,” the researchers wrote. “Although the incidence of DFI declined throughout the first decade of the 21st century, much improvement is still required to reduce DFI and LEA.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.