Structured health care for subjects with diabetic foot ulcers results in a reduction of major amputation rates

Abstract

ObjectiveWe tested the effects of structured health care for the diabetic foot in one region in Germany aiming to reduce the number of major amputations.Research design and methodsIn a prospective study we investigated patients with diabetic foot in a structured system of outpatient, in-patient and rehabilitative treatment. Subjects were recruited between January 1st, 2000 and December 31, 2007. All participants underwent a two-year follow-up. The modified University of Texas Wound Classification System (UT) was the basis for documentation and data analysis. We evaluated numbers of major amputations, rates of ulcer healing and mortality. In order to compare the effect of the structured health care program with usual care in patients with diabetic foot we evaluated the same parameters at another regional hospital without interdisciplinary care of diabetic foot (controls).Results684 patients with diabetic foot and 508 controls were investigated. At discharge from hospital 28.3% (structured health care program, SHC) vs. 23.0% (controls) of all ulcers had healed completely. 51.5% (SHC) vs. 49.8% (controls) were in UT grade 1.Major amputations were performed in 32 subjects of the structured health care program group (4.7%) vs. 110 (21.7%) in controls (p<0.0001). Mortality during hospitalization was 2.5% (SHC) vs. 9.4% in controls (p<0.001).ConclusionsWith the structured health care program we achieved a significant reduction of major amputation rates by more than 75% as compared to standard care.

Chronic Lower Limb Wound Outcomes Among Rural and Urban Veterans

“…In this study, about three quarters of the wounds healed during 1 year of follow‐up, with a median time to healing of around 18 weeks. This is similar to other studies, in which the proportion healed ranges between 63% and 87% . It is more difficult to compare our observed time to healing with other studies since many have limited follow‐up (eg, 20 weeks when comparing different treatments) or include acute and chronic wounds.…”

“…Rural veterans also receive less specialized care than urban veterans . Coordinated, specialized wound care has been shown to improve chronic wound healing . Together, this lower wound care utilization and, in particular, lower utilization of specialty wound care might lead to poorer wound outcomes among rural veterans.…”

Improving major amputation rates in the multicomplex diabetic foot patient: focus on the severity of peripheral arterial disease

“…We therefore conducted this prospective observational study with an 8-year inclusion and a 2-year post-treatment observation period. The central objective of the main project, a dramatic reduction of major amputation in diabetic foot patients, was achieved by introducing structured care for the diabetic foot [Weck et al 2013]. …”

Diabetiske fotsårteam i norske sykehus

“…This implies that the service for patients with diabetic foot ulcers is vulnerable. Previous research (14,17) underlines the cost-benefit effect and the importance of diabetic foot ulcer teams for healing time and the rates of amputation and mortality. It is also pointed out in national professional guidelines for diabetes (8) that diabetic foot ulcer teams can provide better use of resources since a large number of new/alternative treatment methods require experience and competence.…”

“…This is deemed to enable a more systematic treatment of diabetic foot ulcers, a shorter period of healing, and fewer amputations resulting from foot ulcers (14)(15)(16).…”