To determine the incidence of foot ulcers in a large cohort of patients with diabetes,
the risk of developing serious complications after diagnosis, and the attributable
cost of care compared with that in patients without foot ulcers.
Retrospective cohort study of patients with diabetes in a large staff-model health
maintenance organization from 1993 to 1995. Patients with diabetes were identified
by algorithm using administrative, laboratory, and pharmacy records. The data were
used to calculate incidence of foot ulcers, risk of osteomyelitis, amputation, and
death after diagnosis of foot ulcer, and attributable costs in foot ulcer patients
compared with patients without foot ulcers.
Among 8,905 patients identified with type 1 or type 2 diabetes, 514 developed a foot
ulcer over 3 years of observation (cumulative incidence 5.8%). On or after the time
of diagnosis, 77 (15%) patients developed osteomyelitis and 80 (15.6%) required amputation.
Survival at 3 years was 72% for the foot ulcer patients versus 87% for a group of
age- and sex-matched diabetic patients without foot ulcers (P < 0.001). The attributable
cost for a 40- to 65-year-old male with a new foot ulcer was $27,987 for the 2 years
The incidence of foot ulcers in this cohort of patients with diabetes was nearly 2.0%
per year. For those who developed ulcers, morbidity, mortality, and excess care costs
were substantial compared with those for patients without foot ulcers. The results
appear to support the value of foot-ulcer prevention programs for patients with diabetes.