Chapter 28. Epidemiology of Diabetic Foot Ulcers and Amputations: Evidence for Prevention

  1. R. Williams3,
  2. W. Herman4,
  3. A.-L. Kinmonth6 and
  4. N. J. Wareham5
  1. Gayle E. Reiber1 and
  2. William R. Ledoux2

Published Online: 9 APR 2003

DOI: 10.1002/0470846585.ch28

The Evidence Base for Diabetes Care

The Evidence Base for Diabetes Care

How to Cite

Reiber, G. E. and Ledoux, W. R. (2002) Epidemiology of Diabetic Foot Ulcers and Amputations: Evidence for Prevention, in The Evidence Base for Diabetes Care (eds R. Williams, W. Herman, A.-L. Kinmonth and N. J. Wareham), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/0470846585.ch28

Editor Information

  1. 3

    Nuffield Institute for Health, University of Leeds, 71-75 Clarendon Road, Leeds LS2 9PL, UK

  2. 4

    Department of Internal Medicine and Epidemiology, 1500 East Medical Center Drive, 3920 Taubman Center, Box 0345, Ann Arbor, MI 48109, USA

  3. 5

    Department of Public Health and Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

  4. 6

    General Practice and Primary Care Research Unit, Dept. of Public Health & Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

Author Information

  1. 1

    Department of Health Services and Epidemiology, University of Washington, VA Research Career Scientist, VA Puget Sound Health Care System (152), 1660 South Columbia Way, Seattle, WA 98108, USA

  2. 2

    Health Research Scientist, VA Puget Sound, MS 151, 1660 S Columbia Way, Seattle, WA 98108, USA

Publication History

  1. Published Online: 9 APR 2003
  2. Published Print: 27 AUG 2002

ISBN Information

Print ISBN: 9780471988762

Online ISBN: 9780470846582

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Keywords:

  • risk factor;
  • patient education;
  • self-management;
  • foot examination;
  • therapeutic footwear;
  • health care delivery;
  • diabetes duration;
  • glycemic control;
  • peripheral neuropathy;
  • peripheral vascular disease

Summary

Many people with diabetes develop lower-limb complications, frequently including foot ulcers and amputations. Foot ulcers are lesions that include loss of the epithelium and may extend into the dermis and deeper layers, sometimes involving bone and muscle. Amputation is the removal of a terminal, non-viable portion of a limb. This chapter reviews the risk factors and causal pathways for ulcers and amputations in people with diabetes from analytic or experimental studies and presents evidence-based interventions for their prevention. The evidence includes patient education, foot-related self-management, foot examinations, therapeutic footwear and system changes to foot health care delivery. The risk factors are identified as longer diabetes duration, impaired glycemic control, peripheral neuropathy and peripheral vascular disease. The most promising interventions are patient self-management, education and alterations in systems of care.