The present study investigated trends in the incidence of hospitalisation for diabetic foot disease (including ulceration, cellulitis, osteomyelitis, peripheral artery disease and neuropathy) and amputations in Australia from 2010 to 2019. Data on 70 766 people with type 1 diabetes and 1 087 706 with type 2 diabetes, from the three most populous states as well as the Australian Capital Territory, were included.
Over the study period, among the total cohort, there were 158 434 hospitalisations for diabetic foot disease, 31.6% of which were for ulceration, 28.5% for cellulitis, 17.5% for peripheral artery disease, 14.6% for neuropathy and 7.8% for osteomyelitis. There were also 22 705 amputations, 80% of which were of the toe or foot.
Among people with type 1 diabetes, age-adjusted rates of hospitalisations for diabetic foot disease increased from 20.8 to 30.5 per 1000 person-years over the study period. Significant annual percent changes were observed for ulceration (13.3% from 2015 to 2019), neuropathy (8.7% throughout the whole study period), peripheral artery disease (7.7% throughout) and osteomyelitis (5.6% throughout), whereas rates of cellulitis and amputations remained relatively stable. In general, males had higher rates of hospitalisation than females, and people with type 1 diabetes had higher rates than those with type 2 diabetes.
Sensitivity analysis in the type 2 cohort suggested that increased duration of diabetes accounted for some of the observed increase in hospitalisations; however, they highlight specific strategies that could help to reduce this, including enhanced cardiovascular risk management in primary care, more ambulatory multidisciplinary diabetic foot clinics in secondary care, and more appropriate antibiotic usage and revascularisation procedures in specialised care.
Daniel Flanagan cautions against over-simplifying the education we provide about exercise and type 1 diabetes.
24 Mar 2023