A multidisciplinary team reduces in‐hospital clinical complications and mortality in patients with diabetic foot ulcers

Abstract

AimsThe current study aims to evaluate the effectiveness of a multidisciplinary diabetic foot team (MDFT) in the management of in‐patients affected by diabetic foot problems.Materials and MethodsThe study was a retrospective observational study. Consecutive patients with a diabetic foot problem requiring hospitalisation were included. All patients were managed by a MDFT led by diabetologists according to the guidance. The rate of in‐hospital complications (IHCs), major amputation, and survival were recorded at the end of patient’s hospitalisation. IHC was defined as any new infection different from wound infection, cardiovascular events, acute renal injury, severe anaemia requiring blood transfusion, and any other clinical problem not present at the assessment.ResultsOverall, 350 patients were included. The mean age was 67.9 ± 12.6 years, 254 (72.6%) were males, 323 (92, 3%) showed Type 2 diabetes with a mean duration of 20.2 ± 9.6 years; 224 (64%) had ischaemic diabetic foot ulcers (DFUs) and 299 (85.4%) had infected DFUs. IHCs were recorded in 30/350 (8.6%) patients. The main reasons for IHCs were anaemia requiring blood transfusion (2.8%), pneumonia (1.7%), acute kidney failure (1.1%). Patients with IHCs showed a higher rate of major amputation (13.3 vs. 3.1%, p = 0.02) and mortality (16.7 vs. 0.6%, p < 0.0001) in comparison to those without. Ischaemic heart disease (IHD) and wound duration at the assessment (>1 month) were independent predictors of IHC, whereas IHCs, heart failure, and dialysis were independent predictors of in‐hospital mortality.ConclusionsThe multidisciplinary management of diabetic foot problems leads to an IHC rate of 8%. The risk of IHCs is higher in patients with IHD and long wound duration.

Current knowledge of morbidities and direct costs related to diabetic foot disorders: a literature review

“…A diabetic foot ulceration (DFU) multidisciplinary team approach is highly recommended and has been shown to be the most effective strategy for reducing the rates of amputation and mortality in diabetic foot disorders ( 6 , 7 ). Ideally, this team should include a diabetologist, podiatrist, infectious disease specialist, orthopedic surgeon, vascular surgeon, physiotherapist orthotist, diabetes nurse, and an interventional radiologist ( 8 , 9 ). The team’s skills include wound care such as surgical and non-surgical wound debridement, adapted exudate control, vascular assessment, off-loading treatment, glycemia, lipid profile and blood pressure control, vascular and infection assessment, and, if required, revascularization procedures, antibiotic administration, and eventually amputation.…”