Reduction of Major Amputations after Starting a Multidisciplinary Diabetic Foot Care Team: Single Centre Experience from Turkey

Yeşil, Sena; Akıncı, Barış; Bayraktar, Fırat; Havıtçıoğlu, Hasan; Karabay, Özalp; Yapar, Nur; Demirdöver, Cenk; Yener, Serkan; Yalçın, Mihriban; Çömlekçi, Abdurrahman; Eraslan, Sevinç

doi:10.1055/s-0028-1112149

Cited by 36 publications

(25 citation statements)

References 10 publications

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“…The other studies conducted by Yesil et al [22] and Karakoc et al [21] had primarily examined the efficacy of multidisciplinary approach to diabetic foot disease and had made a comparison between amputation rates before and after multidisciplinary approach is realized. We also set the data of the patients after diabetic team's beginning.…”

Section: Discussionmentioning

confidence: 98%

“…Although not all studies have been designed to evaluate amputation rates, the amputation rates from these various studies range from 9.4 to 64.5% [18][19][20][21][22]. Since these studies were looking for different issues other than rate of amputation, gathering standard information is impossible related to amputation risks, hospitalisation, microorganisms grown in cultures, osteomyelitis rates and Wagner grades.…”

Section: Discussionmentioning

confidence: 99%

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Change in amputation predictors in diabetic foot disease: effect of multidisciplinary approach

Aydín

Işıldak

Karakaya

et al. 2010

Endocr

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Diabetic foot disease causes important morbidity in diabetic population, and amputation due to diabetic foot disease occurs more often than in general population. We have been evaluating patients with diabetic foot disease in a multidisciplinary approach since year 2000. In the current study, we sought to investigate the change in amputation rate and its predictors in diabetic foot with a multidisciplinary team approach. Seventy-four patients (52 male, 22 female) hospitalised between January 2002 and December 2007 were retrospectively analysed. Sixteen out of 74 have undergone amputation. We found overall amputation rate as 21.6%, which is lower than previously reported from our institution (36.7 and 39.4%, respectively). Major amputations (syme, below-knee, above-knee) were applied to 11 patients (14.9%). A logistic regression model including osteomyelitis, peripheral neuropathy, peripheral vascular disease, hypertension, gangrene and age revealed that gangrene is now the only significant predictor for amputation. Our observations confirm that amputation rate has declined after implementation of a multidisciplinary team work, and risk factors apart from presence of gangrene are no longer amputation predictors in our centre.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Change in amputation predictors in diabetic foot disease: effect of multidisciplinary approach

Aydín

Işıldak

Karakaya

et al. 2010

Endocr

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“…In Spain, during the period 2001-2008, the rate of non-traumatic amputations in T2DM patients, instead of diminishing, has increased [25,26], indicating the urgency of caring for and preventing foot injuries. The evidence shows that it is possible to reduce the number of amputations [27][28][29], by means of a correct Diabetes Service organization and the control of different risk factors [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Angiotensin Converting Enzyme Gene Polymorphism as a Genetic Biomarker of Diabetic Peripheral Neuropathy: Longitudinal Prospective Study

Jurado¹,

Ybarra²,

Romeo³

2012

J Neurol Neurophysiol

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In addition to the proven association between metabolic control and complications of diabetes, there is a clear familial predisposition and likely link with genetic factors [12] expressed by the absence of complications in some patients with poor metabolic control. AbstractBackground: Identifying patients at risk of developing diabetic peripheral neuropathy (DPN) is of paramount importance in those with type 2 diabetes mellitus (T2DM) to provide and anticipate secondary prevention measures as well as intensify action on risk factors, particularly so in primary care. Noteworthy, the incidence of DPN remains unknown in our environment.Aims: i) to analyze Angiotensin Converting Enzyme (ACE) gene polymorphisms as a genetic marker of risk of developing DPN, ii) to determine the incidence of DPN in our environment. Research design and methods:Longitudinal prospective cohort study with three years of follow-up involving a group of T2DM (N=283) randomly selected. ACE gene polymorphisms distribution (I=insertion; D=deletion) was determined. DPN was diagnosed using clinical and neurophysiology evaluation.Results: Baseline DPN prevalence was 28.97% (CI95%:23.65-34.20), ACE polymorphism heterozygous genotype D/I presence was 60.77% (CI95%:55.05-66.5) and was independently associated with a decreased risk of DPN, RR: 0.51 (CI95%, 0.30-0.86). DPN correlated with age (p<0.001) but not with gender (p=0.466) or time of evolution of T2DM (p=0.555). End Point: DPN prevalence was 36.4% (CI95%, 30.76-42.04) and accumulated incidence was 10.4% three years thereafter. In the final Poisson regression analysis, the presence of heterozygous genotype remained independently associated with a decreased risk of DPN, RR 0.71 (CI95%, 0.53-0.96). DPN presence remained correlated with age (p=0.002), but not with gender (p=0.490) or time of evolution (p=0.630). Conclusions:In our series, heterozygous ACE polymorphism (D/I) stands as a protective factor for DPN development. Accumulated incidence of DPN was relevant. Further prospective studies are warranted.

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“…Alle 40 s erfolgt zurzeit irgendwo auf unserer Welt eine Amputation im Gefolge dieser von der WHO als Epidemie bezeichneten Erkrankungen [42]. Eine "epidemische Ausbreitung" wird damit der einzigen Nicht-Infektionskrankheit attestiert.…”

Section: Trend 6: Prävention Und Versorgungsforschungunclassified

Entwicklung der Gefäß- und Endovaskularchirurgie in den nächsten 20 Jahren

Schmitz‐Rixen

Lang

2009

Chirurg

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Vascular surgery is a young surgical discipline which has experienced a stormy development driven by internal motivation and external constraints. Changes in the field are primarily a result of diverse external influences which are expected to continue into the future. The most significant intrinsic change has been the development of stent graft technology. External influences include extensive demographic changes, rapid progress in endovascular techniques to treat obstructive vascular disease, improved advanced training, state and non-state controls, certification requests without considering the feasibility of professional and structural implementation and changing public expectations. Progress in vascular medicine is stimulated by advances in imaging techniques and subsequent improved endovascular procedures. Nevertheless, external influences have, at least within the 'surgical' sphere of influence, led to formidable innovative efforts on the part of associations representing vascular surgeons. These innovative efforts are concentrated in the Academy of the German Society of Vascular Surgery and Medicine and will determine trends in coming years. The future will reflect their quality.

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Reduction of Major Amputations after Starting a Multidisciplinary Diabetic Foot Care Team: Single Centre Experience from Turkey

Abstract: Our results demonstrated that major amputation rates can be reduced by team work. Formation of multidisciplinary diabetic foot care teams and clinics should be encouraged in Turkey.

Cited by 36 publications

References 10 publications

Change in amputation predictors in diabetic foot disease: effect of multidisciplinary approach

Change in amputation predictors in diabetic foot disease: effect of multidisciplinary approach

Angiotensin Converting Enzyme Gene Polymorphism as a Genetic Biomarker of Diabetic Peripheral Neuropathy: Longitudinal Prospective Study

Entwicklung der Gefäß- und Endovaskularchirurgie in den nächsten 20 Jahren

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