May 18, 2016
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Diabetes affects 30 million people in the US and more than 415 million people worldwide. Diabetes Association


The big picture: Diabetes, Diabetic Foot Ulcers, Peripheral Artery Disease and Limb Loss Visualized


The top 10 diabetes nations 
International Diabetes Federation /


Worldwide trends in diabetes from 1980 to today


Diabetes kills more people annually than breast cancer and AIDS combined.

American Diabetes Association, 2009


Two thirds of all new cases of type 2 diabetes are diagnosed in low- and middle-income countries, such as Mexico, India, China and Egypt.

Pharmacoeconomics, 2015


Diabetes reduces a woman’s chances of employment by 50%

Pharmacoeconomics, 2015


If diabetes were a country, it would be the 4th largest in the world

International Diabetes Federation /


80% of people with diabetes are from low and middle income nations

International Diabetes Federation, 2012


The number of people with diabetes is increasing in every single nation

International Diabetes Federation/World Health Org 2012


Half of people with diabetes don’t know they have it.

American Diabetes Association / International Diabetes Federation, 2012


Quiet. Slow. Deadly. Expensive: Chronic Diseases Account for 75% of our Healthcare Costs.



25% of all medical care is consumed by 1% of the population and nearly 50% is consumed by 5%.
AHRQ, 2013


1 Day with #Diabetes in USA:  5000 diagnosed, $670M, 280 lives, 200 limbs. We can do better. Today.
American Diabetes Association, 2014


Seconds Count: Every 7 seconds someone dies from diabetes. Every 20 seconds someone is amputated.

International Diabetes Federation /

Armstrong, et al, Diabetes Care 2013


The cost of diabetic foot ulcers is greater than that of the five most costly forms of cancer

Barshes, et al, Diab Foot Ankle 2013


The cost to heal a complex diabetic foot ulcer is between 3 months and 6 years’ salary depending on nationality

Cavanagh, et al, Diabetes Metab Res Rev, 2012


Diabetic Foot Ulcer patients are twice as costly to US Medicare as those with diabetes alone

Rice, et al, Diabetes Care, 2014


Inpatient care constitutes nearly two thirds of insurance costs for diabetic foot ulcers
Rice, et al, Diabetes Care, 2014


The estimated annual US Burden of Diabetic Foot Ulcers is at least $15 Billion
Rice, et al, Diabetes Care, 2014


By 2030, at least 550 million people will have diabetes- approximately 10% of the world’s adult population.

International Diabetes Federation (IWGDF), 2011


There are now approximately 86M people with pre-diabetes in the USA
That’s the total population of 30 states. 
American Diabetes Association, 2014
2010 United States Census


The population of diabetes in the USA is greater than the population of the nation’s 10 largest cities.
American Diabetes Association, 2012
2010 United States Census


Today with Diabetes In America: 200 Lives, 200 Limbs, 86 million at risk.
American Diabetes Association 2014


The population of Diabetes in Arizona (home of SALSA) would make it the fourth largest city in the state.
American Diabetes Association, 2012
2010 United States Census


60-70% of those with diabetes will develop peripheral neuropathy, or lose sensation in their feet.

Dyck et al.  Diabetic Neuropathy 1999


More than 90% of people with diabetic peripheral neuropathy are unaware they have it.

Bongaerts, et al, Diabetes Care, 2013


Up to 25% of those with diabetes will develop a foot ulcer.

Singh, Armstrong, Lipsky.  J Amer Med Assoc 2005


The yearly incidence of diabetic foot ulcers ranges from 2% to 32%, depending on ADA risk classification
Boulton, Armstrong, et al, Diabetes Care 2008
Lavery , et al, Diabetes Care  2008
Sibbald, et al, Adv Skin Wound Care, 2012


More than half of all foot ulcers (wounds) will become infected, requiring hospitalization and 20% of infections result in amputation.

Lavery, Armstrong, et al.  Diabetes Care 2006


Diabetes contributes to approximately 80% of the 120,000 nontraumatic amputations performed yearly in the United States.

Armstrong et al. Amer Fam Phys 1998


“Every 20 seconds, somewhere in the world, a limb is lost as a consequence of diabetes”

DFCon11, Bakker (after Boulton),

Boulton, The Lancet (cover), Nov. 2005


After a major amputation, 50% of people will have their other limb amputated within 2 years.

Goldner. Diabetes 1960

Armstrong, et al, J Amer Podiatr Med Assn, 1997


More than half of people with  osteomyelitis of the heel will undergo high level amputation

Faglia, et al, Foot Ankle Int, 2013


The relative 5-year mortality rate after limb amputation is 68%. When compared with cancer – it is second only to lung cancer (86%).  (Colorectal cancer 39%, Breast cancer 23%, Hodgkin’s disease 18%, Prostate cancer 8%)

Armstrong, et al, International Wound Journal, 2007


Median time to healing for diabetic foot wounds: 147,188, and 237 days for toe, midfoot and heel ulcers.

Pickwell, et al, Diabetes Metab Res Rev, 2013


People with a history of a diabetic foot ulcer have a 40% greater 10 year mortality than people with diabetes alone.

Iversen, et al, Diabetes Care, 2009


Every 30 minutes a limb is lost due to a landmine, Every 20 seconds, a limb is lost due to diabetes.

Bharara, Mills, Suresh, Armstrong, Int Wound J, 2009


Having a wound immediately doubles one’s chances of dying at 10 years compared with someone without diabetes

Iversen, et al, Diabetes Care 2009


One third of patients seeking care for ischemic wounds die unhealed
Elgzyri, et al, Eur J Vasc Endovasc Surg, 2013


For people on dialysis receiving an amputation, 2 year mortality is 74%

Ndip, et al, 2012, Diabetes


Diabetic foot ulcers double mortality and heart attack risk while increasing risk for stroke by 40%
Brownrigg, et al, Diabetologia, 2012


Chronic wounds affect some 8 million Americans each year. That’s one wound every 3.8 seconds in the USA, alone.
Harsha , 2008 and Tomic-Canic 2010


Each $1 invested in care by a podiatrist for people with diabetes results in $27 to $51 of healthcare savings.

JAPMA, 101(2), 2011


Podiatry care not only reduces amputation risk, but also dramatically impacts rate of hospitalization and reulceration
Gibson, et al, Int Wound Journal, 2013


Podiatric medical care in people with history of diabetic foot ulcer can reduce high level amputation from between 65% and 80%
Gibson, et al, Int Wound Journal, 2013


Instituting a structured diabetic foot program can yield a 75% reduction in amputation rates and a near four-fold reduction in inpatient mortality
Weck, et al,  Cardiovascular Diabetology, 2013


When footcare is removed from a population with diabetes, there is a 37% increase in hospital admissions for limb threatening wounds and 45% increase in individual patient charges.

Skrepnek, Mills, Armstrong, Diabetes Care, 2014


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