The purpose of this stud y is to investigate the medical, epidemiological, and financial aspects of diabetic patients who were hospitalized because of diabetic foot problems in Akdeniz University School of Medicine, Division of Endocrinology during 1995-1998 (n=58; 21 females,37 males; 56 NIDDM, 2 IDDM; age 60.5±10 years; duration of diabetes 15.1±8.1 years). The time period between the appearance of foot lesions and hospitalisation was 30 (7-360) days. Twenty patients had Grade IV, 27 Grade III, 10 Grade II, 1 Grade I diabetic foot (according to Wagner's classification). In 35 patients, osteomyelitis was suggested by Tc 99m-MDP three phase bone scanning; 17 of these patients had a normal bone x-ray. One or more organisms were identified in aerobic wound culture of 32 patients. Clindamycin and fluoroquinolones were given empirically. The most frequently isolated agent was S.aureus. Angiography was performed in 18 patients in whom physical examination and/or Doppler ultrasound suggested arterial insufficiency and 11 had severe stenosis or occlusion. Above or below knee amputations were performed in 13 patients; 5 of these patients had severe arterial insufficiency established by angiog raphy, 2 by Doppler ultrasound, 4 by physical examination. Forty five patients improved with medical and/or conservative surgical therapy. The median duration of hospitalization was 21(4-81) days, and median treatment cost per patient was 1292 (110-9420) US dollars. The median hospitalisation period and cost per person was 11 days, 710 $ for grade II; 22 days, 1215 $ for grade III and 28 days, 2190 $ for grade IV ulcers. All grade I and grade II, 24 of 27 grade III, and 10 of 20 grade IV ulcers were cured by conservative therapy. Major amputation was performed in 3 grade III and 10 grade IV ulcers.
Keywords: Diabetic foot, management, osteomyelitis, amputation, cost