title: Diabetic charcot neuroarthropathy: prevalence, demographics and outcome in a regional referral centre.
abstract: BACKGROUND
  Diabetic Charcot neuroarthropathy (DCN) is a devastating complication for people with diabetes mellitus. The failure to diagnose DCN and institute treatment in the acute phase leads to permanent deformity and significant morbidity. There is a paucity of data on the prevalence and characteristics of patients who have developed this complication of diabetes.
  
  
  OBJECTIVE
  To determine the prevalence, clinical characteristics and outcomes of patients with DCN from 2006 to 2012.
  
  
  METHODS
  Case finding was performed by searching three independent lists for the period 2006-2012 including: SYNGO radiology database, HIPE database of hospital discharges, and, combined list from podiatry, endocrinology, vascular surgery and orthopaedic clinics. A consensus meeting with chart review was undertaken to confirm diagnosis of DCN. A proforma was completed from chart review to determine clinical characteristics, initial treatment and outcomes for patients with DCN.
  
  
  RESULTS
  Forty cases of DCN were identified, resulting in an estimated period prevalence of 0.3 %. The majority of patients were male (68 %); most patients had T2DM (73 %). Mean ± SD for age was 58 ± 10 years and mean duration of diabetes was 15 ± 9 years. In the acute phase of DCN, offloading was performed in 50 %. Bisphosphonates were administered to 5 % and surgery undertaken in 5 % of cases. 38 % of patients developed subsequent foot ulceration and 20 % required amputation.
  
  
  CONCLUSIONS
  This is the first prevalence estimate of DCN in Ireland. These data suggest diagnosis of DCN is missed in the acute phase. There exists a significant risk of diabetic foot ulceration and amputation with DCN.
authors.affiliation: Department of Diabetes, St. Vincent's University Hospital, Dublin, Ireland. aonghus_o_loughlin@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: O'Loughlin
authors.affiliation: Department of Podiatry, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: E
authors.initials: E
authors.lastname: Kellegher
authors.affiliation: Department of Podiatry, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: McCusker
authors.affiliation: Department of Diabetes, St. Vincent's University Hospital, Dublin, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Canavan
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D001177:Arthropathy, Neurogenic / Q000628:therapy*; D017719:Diabetic Foot / Q000473:pathology*; D003929:Diabetic Neuropathies / Q000628:therapy*; D005260:Female; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011859:Radiography; D012017:Referral and Consultation; D012189:Retrospective Studies
keywords: Amputation; Charcot; Diabetes mellitus; Neuroarthropathy; Ulceration