Diabetes: Foot Exam

The percentage of patients 18-75 years of age with diabetes (type 1 and type 2) who received a foot exam (visual inspection and sensory exam with mono filament and a pulse exam) during the measurement year

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As the seventh leading cause of death in the U.S., diabetes kills approximately 75,000 people a year (CDC FastStats 2015). Diabetes is a group of diseases marked by high blood glucose levels, resulting from the body's inability to produce or use insulin (CDC Statistics 2014, ADA Basics 2013). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death. (CDC Fact Sheet 2014). 

In 2012, diabetes cost the U.S. an estimated $245 billion: $176 billion in direct medical costs and $69 billion in reduced productivity. This is a 41 percent increase from the estimated $174 billion spent on diabetes in 2007 (ADA Economic 2013).  

Complications due to improper or poor quality of foot care in diabetics can include amputations of the toe, foot, lower and upper leg. Between 1993 and 2009, the CDC monitored the rates of nontraumatic amputations in the diabetic population. Overall, the rates peaked in 1996 with toe amputations at 3.7 per 1,000 diabetic population. Amputations for the foot, lower leg, and upper leg were 1.5, 2.3, and 1.1 per 1,000 diabetic population, respectively, in 1996. Since the late nineties, lower extremity amputation rates in the diabetic population have declined, witnessed by the following rates in 2009: for toe amputations (1.8 per 1,000 diabetic population), followed by lower leg (0.9), foot (0.5) and upper leg (0.4) amputations (CDC, 2012).

American Diabetes Association (2015) Guidelines/ Recommendations: Perform annual comprehensive foot examination to identify risk factors predictive of ulcers and amputations. The foot examination should include inspection, assessment of foot pulses, and testing for loss of protective sensation (10-g monofilament plus testing any one of: vibration using 128-Hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold).

Higher score indicates better quality

American Diabetes Association. Microvascular complications and foot care. Sec. 9. In Standards of Medical Care in Diabetesd2015. Diabetes Care 2015;38(Suppl. 1):S58-S66

American Diabetes Association (ADA). 2013. Diabetes Statistics. Retrieved from http://www.diabetes.org/diabetes-basics/diabetes-statistics/.  

Centers for Disease Control and Prevention (CDC). 2012. CDC's Diabetes Program-Data and Trends-Diabetes Surveillance System-Nontraumatic Lower Extremity Amputation with Diabetes by Level of Amputation. Retrieved from http://www.cdc.gov/diabetes/statistics/lealevel/fig8.htm.

Centers for Disease Control and Prevention (CDC). 2014. National Diabetes Statistics Report. http://www.cdc.gov/diabetes/pdfs/data/2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.pdf

Centers for Disease Control and Prevention (CDC). 2015. FastStats: Deaths and Mortality. www.cdc.gov/nchs/fastats/deaths.htm.

Centers for Disease Control and Prevention. 2014. CDC Features. Diabetes Latest. www.cdc.gov/features/diabetesfactsheet/.

American Diabetes Association. 2013. Diabetes Basics. www.diabetes.org/diabetes-basics/?loc=GlobalNavDB

American Diabetes Association (ADA). April 2013. Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care. Vol. 36 no. 4
1033-46. http://care.diabetesjournals.org/content/36/4/1033.full

Foot exam: visual inspection with either a sensory exam or a pulse exam

Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included

TBD

Patients 18-75 years of age with diabetes with a visit during the measurement period

Equals Initial Population

Patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period

Patients who received visual, pulse and sensory foot examinations during the measurement period

Not Applicable

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For every patient evaluated by this measure also identify payer, race, ethnicity and sex

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