Abstract
ObjectiveTo assess the improvement in the management of diabetes and its complications based on the evolution of hospitalisation rates for diabetic foot ulcer (DFU) and lower extremity amputation (LEA) in individuals with diabetes in France.MethodsData were provided by the French national health insurance general scheme from 2008 to 2014. Hospitalisations for DFU and LEA were extracted from the SNIIRAM/SNDS French medical and administrative database.ResultsIn 2014, 22,347 hospitalisations for DFU and 8,342 hospitalisations for LEA in patients with diabetes were recorded. Between 2008 and 2014, the standardised rate of hospitalisation for DFU raised from 508 to 701/100,000 patients with diabetes. In the same period, the standardised rate of LEA decreased from 301 to 262/100,000 patients with diabetes. The level of amputation tended to become more distal. The proportion of men (69% versus 73%) and the frequency of revascularization procedures (39% versus 46%) increased. In 2013, the one-year mortality rate was 23% after hospitalisation for DFU and 26% after hospitalisation for LEA.ConclusionsFor the first time in France, the incidence of a serious complication of diabetes, i.e. amputations, has decreased in relation with a marked improvement in hospital management.
Highlights
While the prevalence of diabetes is increasing in developed countries, the quality of management of diabetes is improving and the cost of management is increasing [1]
Guidelines on screening and management of patients with diabetes at risk of foot ulcer have been published by various scientific societies, especially the International Working Group on the Diabetic Foot (IWGDF), since 2007 [8,9,10]
The Système national d’information interregimes de l’Assurance maladie (SNIIRAM) does not contain any clinical data concerning the results related to prescriptions or examinations, but includes information on the possible presence of long-term diseases (LTD), such as diabetes, which are eligible for 100% reimbursement of healthcare expenditure at the physician’s and patient’s request, following approval by a national health insurance physician
Summary
While the prevalence of diabetes is increasing in developed countries, the quality of management of diabetes is improving and the cost of management is increasing [1]. In France, the estimated prevalence of pharmacologically treated diabetes was 5.0% in 2016, within the mean range observed in Europe, with an adjusted (age and region) annual growth rate of + 0.9% and + 0.4%, respectively for men and women, between 2010 and 2017 [2]. Diabetic foot ulcer (DFU) most often results from the combination of two major complications of diabetes: diabetic neuropathy and arterial disease. It can be complicated by soft tissue and bone infection. Guidelines on screening and management of patients with diabetes at risk of foot ulcer have been published by various scientific societies, especially the International Working Group on the Diabetic Foot (IWGDF), since 2007 [8,9,10]
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