OBJECTIVES: The objective of the current review was to summarize burden of diabetic foot ulcers (DFUs) in Indian patients based on findings reported in published literature.

METHODS: MEDLINE was queried using key words: foot ulcer; diabetes mellitus; infection; diabetic foot ulcer. Evidence was synthesized from shortlisted articles, presenting epidemiology, microbiology and economic burden of DFUs in Indian patients.

RESULTS: In India, DFUs affect 15% of diabetics during their lifetime. Mono/polymicrobial etiology of diabetic foot infections was widely reported including high prevalence of Pseudomonas, E. coli, and S. aureus infections. Evidence from published literature showed 100,000 leg amputations/ year due to diabetes-related problems and an expense of approximately $1,960 for complete treatment of DFUs. Out of 62 million diabetics in India, 25% develop DFUs, of which 50% become infected, requiring hospitalization while 20% need amputation. DFUs contribute to approximately 80% of all non-traumatic amputations in India, annually. Patients with a history of DFU have 40% higher 10-year death-rate, than those without. Average time required for healing of DFUs is 28 weeks (range 12-62 weeks). Two studies indicated that patients with DFUs spent four times more than those without (Satyavani, 2013: Rs.19,020 (~$295.95) vs. Rs. 4,493(~$69.91)) and (Shobhana, 2001: Rs. 15,450(~$240.40) vs. Rs. 4,373(~$68.04)). Also, India is the most expensive country for DFU care, as 5.7 years (68.8 months) of an average patient’s income is required to pay for complete DFU therapy. Amongst Indian diabetics, treatment cost of neuropathic ulcers (ambulatory care), infected neuropathic foot (ambulatory care), advanced diabetic foot (salvage, limb amputation, salvage followed by amputation), and neuroischemic foot (bypass) was reported as $56, $165, $1080, $960, $2650 and $1960, respectively. Moreover, 50% of DFU patients who get amputated once, suffer another amputation within next 2 years.

CONCLUSIONS: DFU specific clinical guidelines and cost-effective therapies need to be developed urgently to halt this catastrophic pandemic.