Solving the Racial Disparity in Diabetic Foot Ulcer Prevalence

Diabetic foot ulcers can cause a wide range of complications, but more aggressive management solutions and population-based screenings can help decrease their burden.

Diabetic foot ulcers are one of the most prominent sources of preventable morbidity among adults with diabetes and can result in declining function, infection, hospitalization, amputation, and even death. With a lifetime risk of 19–34% and rising due to increased longevity, managing foot ulcers and the complications that come with them is an area of high concern for the medical community. This article, published in Diabetes Care, reviews the epidemiology, presentation, and sequelae of diabetic foot ulcers, and then provides a summary of the current best evidence-based approaches to screening and prevention. Prominent disparities in both care and outcomes are also presented and analyzed. 

Diabetic Foot Ulcers are Highly Morbid and Increasingly Common

Diabetic foot ulcers are one of the most difficult complications of diabetes to deal with. Because they are a consequence of long-term, poorly managed diabetes, there is often no highly targeted treatment option that can alleviate the various complications that are associated with these foot ulcers. About 20% of those who develop a diabetic foot ulcer require amputation, and 10% die within a year of their first diabetic foot ulcer diagnosis. Diabetic foot ulcers can co-occur with issues relating to peripheral neuropathy, defined as any complex of signs or symptoms of peripheral nerve dysfunction with no other clear cause. 

Sensory neuropathy leads to pain, loss of proprioception, and temperature sensation, which can predispose individuals with diabetes to unrecognized minor trauma, leading to ulcers later on. Peripheral artery disease can likewise narrow blood vessels in the lower extremities and cause similar symptoms and results. Both are significant risk factors for developing a diabetic foot ulcer. 

Non-White Groups Tend to Face Worse Foot Ulcer Outcomes, but Prevention Can Help

Black, Hispanic, and other non-White groups show much higher incidence rates of diabetes when compared to White adults, and this extends to higher rates of diabetic foot ulcers. Unequal access to care also increases the incidence of diabetic foot ulcers, and racial minorities and those without insurance are more likely to undergo amputation rather than revascularization treatment. Factors like smoking, cardiovascular disease, and chronic kidney disease can also affect the rates of foot ulcers and their negative outcomes. 

Complications related to diabetic foot ulcers can be treated using guideline-directed screening, earlier diagnosis, and aggressive medical management of both diabetes and cardiovascular disease. Current population-based screening is ineffective, and delays in access to diabetic and other specialty care contribute to increased negative outcomes among non-White communities. The authors urge an increase in preventative measures among these population groups, along with more directed management solutions that can limit the rates of severe outcomes such as amputation.

Source:

McDermott, K., Fang, M., Boulton, A. J. M., Selvin, E., & Hicks, C. W. (2023). Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care, 46(1), 209-221. https://doi.org/10.2337/dci22-0043