Mind the Gap: Disparity Between Research Funding and Costs of Care for Diabetic Foot Ulcers

Abstract

Diabetic foot ulceration (DFU) is a serious and prevalent complication of diabetes, ultimately affecting some 25% of those living with the disease (1). DFUs have a consistently negative impact on quality of life and productivity as diabetic patients report stigma, social isolation, unemployment, and depression (2–5). Patients with DFUs also have morbidity and mortality rates equivalent to aggressive forms of cancer (2). These ulcers remain an important risk factor for lower-extremity amputation as up to 85% of amputations are preceded by foot ulcers (6). It should therefore come as no surprise that some 33% of the $116 billion in direct costs generated by the treatment of diabetes and its complications was linked to the treatment of foot ulcers (7). Another study has suggested that 25–50% of the costs related to inpatient diabetes care may be directly related to DFUs (2). National standards have been developed for DFU prevention and care (8–10). Given the high prevalence, severity, costs, and morbidity of diabetic foot complications, one would expect that federal funding for DFU research would be proportionate to its public health impact. The National Institutes of Health (NIH) is the major source of federal funding for medical research in the U.S. We therefore examined NIH funding for both diabetes and DFUs using the NIH Research Portfolio Online Reporting Tools (RePORT) from 2002 to 2011 (11). We also examined differences in the number of peer-reviewed publications (using PubMed at www.ncbi.nlm.nih.gov) on both diabetes and diabetic foot ulcers between the years 1980–2010. The search terms …