Epidemiology

Diabetes mellitus is one of the most common chronic diseases in the UK. In 2023, there were 4.3 million people in the UK living with a diagnosis of diabetes.[3] This issue is global: in 2021, there were estimated to be 529 million people living with diabetes, equivalent to 6.1% of the world’s population.[4] ​​The prevalence of diagnosed diabetes mellitus in adults in the US increased from 7.1% in 2001-2004 to 10.1% in 2017-2020.[5] During 2021, the number of people in the US with diagnosed or undiagnosed diabetes was estimated to be 38.4 million (11.6% of the US population).[6] 

It is estimated that up to one in three people with diabetes will have a diabetic foot ulcer at some point in their lives.[7]​ In 2016, some 131 million people were estimated to be living with diabetes-related lower-extremity complications, equivalent to 1.8% of the global population, with males and people aged 50-69 years disproportionately affected.[8] Diabetes is the most common cause of non-traumatic limb amputation, with foot ulcers preceding more than 80% of amputations.[9] 

Peripheral sensory neuropathy and peripheral arterial disease (PAD) in patients with diabetes have an important role in the development of diabetic foot ulcers and risk of limb loss.[10] The prevalence of sensory neuropathy in diabetic populations is between 40% and 60%.[10] The prevalence of PAD in people with diabetes is 20% to 28%, rising to 50% among those with established diabetic foot ulcers.[11]

In one prospective cohort study of patients with diabetes without ulceration at enrolment, the incident rate of diabetic foot ulcers was 5 per 100 person-years.[12] In England and Wales, 108,450 ulcer episodes in people with diabetes were registered with the National Diabetes Foot Care Audit between 2014 and 2021.[13] There was a steady increase in ulcer episodes each audit year, from approximately 5000 registered in 2014-2015 to approximately 25,000 in 2019-2020 (although there was a decrease in reported episodes in 2020-2021, coinciding with the COVID-19 pandemic).[13] Of those with severe ulcers, 2.7% underwent major amputation (above the ankle) within 6 months, an approximately four-fold higher proportion than those with less severe ulcers, and 15% died within 1 year.[13] 

In the US, the incidence of lower-extremity amputation was 6.8 per 1000 people with diabetes in 2020.[6] Unfortunately, significant treatment variability has been identified both in Europe and the US. 

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