Losing a foot versus losing a dollar; a systematic review of cost studies in diabetic foot complications.

INTRODUCTION: Diabetes mellitus is a chronic disease with high prevalence worldwide and a range of serious related complications. Amongst them, diabetic foot is one of the most disabling, posing a substantial health and economic burden on patients and healthcare systems. Areas covered: According to projections, the expected lower limb morbidity is about to increase - in this light the present review aimed at identifying cost-of-illness studies on the management and treatment of conditions related to the diabetic foot, in an aim to provide a body of evidence for an increasing health care burden. Expert commentary: Recent literature review surfaced a plethora of cost studies. Despite heterogeneity of foot complications and geographic variations, the search methodology revealed substantial costs and further healthcare burden for people with diabetes. Amputations due to suboptimally treated foot infections contribute to the already high rates of hospitalizations and readmissions. The cost of amputation ranges between $35,000 and $45,000 in the developed countries, however it largely depends on the amputation type. Moreover, the findings suggest that the cost of amputation in the US is generally higher compared to the cost in European countries. The cost of amputation in developing countries is substantially lower, as it approximates $5,000.

Effect of traditional Greek Mediterranean meals on platelet aggregation in normal subjects and in patients with type 2 diabetes mellitus.

Patients with type 2 diabetes mellitus have increased risk of cardiovascular disease. Epidemiological studies have shown a correlation between diet and incidence of coronary heart disease. The aim of the study is to determine the effect of a traditional Greek Mediterranean diet on platelet aggregation induced by ADP, arachidonic acid (AA), and especially platelet-activating factor (PAF) on patients with type 2 diabetes mellitus as well as on healthy volunteers. The patients were randomized into two subgroups, A and B. The lipid extracts from traditional Greek Mediterranean-type meals were tested in in vivo for their ability to reduce PAF- or thrombin-induced platelet aggregation. The meals with the most potent anti-aggregating activity were chosen for the diet of both subgroup A and healthy subjects and consumed for a period of 28 days, whereas subgroup B kept to their regular diet that was followed before entering the study. Platelet-rich plasma was isolated before and after the diet, and the ability of platelets to aggregate under the aggregating factors was tested. One-month consumption of diet resulted in a significant reduction in PAF- and ADP-induced aggregation of platelets in both groups of healthy volunteers (PAF and ADP, P < .05) and subgroup A (PAF, P < .001; ADP, P < .05), whereas the AA-induced aggregation was not affected. No effect was observed in subgroup B, which followed the standard diet. Thus the consumption of a traditional Greek Mediterranean diet even for a short period can reduce platelet activity in patients suffering from type 2 diabetes mellitus and in healthy subjects.