Abstract
Introduction: It is widely recognized that a multidisciplinary team is effective in the management
diabetic foot ulcers. Contrary to developed countries, multidisciplinary diabetic
foot care teams and/or clinics have not been constructed in most centres in developing
countries. The aim of this study was to present our data regarding amputation rates
and profiles before and after starting the Dokuz Eylul University multidisciplinary
diabetic foot care team.
Methods: This study includes data from diabetic foot ulcer episodes which were managed in
Dokuz Eylul University Hospital between January 1999 and January 2008. The data was
collected prospectively during a minimum follow-up of 6 months in all ulcers. After
January 2002, management of ulcers was coordinated by the diabetic foot care team
(n=437). Amputation rates were compared to those who were admitted before January
2002 (n=137).
Results: Overall amputation and minor amputation rates were similar for both periods. However,
major amputations were observed to be decreased after starting the Dokuz Eylul University
multidisciplinary diabetic foot care team (20.4% vs. 12.6%, p=0.026).
Conclusions: 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.
Key words
diabetes - foot ulcer - amputation - multidisciplinary team
References
1
Jeffcoate WJ, Harding KG.
Diabetic foot ulcers.
Lancet.
2003;
361
1545-1551
2
▪ ▪.
American Diabetes Association. Consensus Development Conference on Diabetic Foot Wound Care: 7–8 April 1999, Boston,
Massachusetts. American Diabetes Association.
Diabetes Care.
1999;
22
1354-1360
3
Ragnarson Tennvall G, Apelqvist J.
Health-economic consequences of diabetic foot lesions.
Clin Infect Dis.
2004;
39
((Suppl. 2))
S132-S139
4
.
American Diabetes Association. Consensus Development Conference on Diabetic Foot Wound Care. 7–8 April 1999, Boston,
MA. American Diabetes Association.
Adv Wound Care.
1999;
12
353-361
5
Apelqvist J, Bakker K, van Houtum WH. et al .
Practical guidelines on the management and prevention of the diabetic foot: based
upon the International Consensus on the Diabetic Foot (2007) Prepared by the International
Working Group on the Diabetic Foot.
Diabetes Metab Res Rev.
2008;
24
((Suppl. 1))
S181-S187
6
Edmonds M.
The multidisciplinary diabetic-foot clinic.
Int J Low Extrem Wounds.
2008;
7
66-67
7
Knowles EA, Gem J, Boulton AJ.
The diabetic foot and the role of a multidisciplinary clinic.
J Wound Care.
1996;
5
452-454
8
Ghirlanda G, Mancini L, Castagneto M. et al .
The foot clinic. Multidisciplinary management of the patient with diabetic foot.
Rays.
1997;
22
638-643
9
Ragnarson Tennvall G, Apelqvist J.
Health-related quality of life in patients with diabetes mellitus and foot ulcers.
J Diabetes Complications.
2000;
14
235-241
10
Larsson J, Apelqvist J, Agardh CD. et al .
Decreasing incidence of major amputation in diabetic patients: a consequence of a
multidisciplinary foot care team approach?.
Diabet Med.
1995;
12
770-776
11
Holstein P, Ellitsgaard N, Olsen BB. et al .
Decreasing incidence of major amputations in people with diabetes.
Diabetologia.
2000;
43
844-847
12
Unwin N.
The diabetic foot in the developing world.
Diabetes Metab Res Rev.
2008;
24
((Suppl. 1))
S31-S33
13
Ramachandran A.
Specific problems of the diabetic foot in developing countries.
Diabetes Metab Res Rev.
2004;
20
((Suppl. 1))
S19-S22
14
Batista F, Pinzur MS.
Disease knowledge in patients attending a diabetic foot clinic.
Foot Ankle Int.
2005;
26
38-41
15
Parisi M, Zantut-Wittmann D, Pavin E. et al .
Comparison of three systems of classification in predicting outcome of diabetic foot
ulcers in a Brazilian population.
Eur J Endocrinol.
2008;
159
417-422
16
Karakoc A, Ersoy RU, Arslan M. et al .
Change in amputation rate in a Turkish diabetic foot population.
J Diabetes Complications.
2004;
18
169-172
17
Aksoy DY, Gurlek A, Cetinkaya Y. et al .
Change in the amputation profile in diabetic foot in a tertiary reference center:
efficacy of team working.
Exp Clin Endocrinol Diabetes.
2004;
112
526-530
18
Gurlek A, Bayraktar M, Savas C. et al .
Amputation rate in 147 Turkish patients with diabetic foot: the Hacettepe University
Hospital experience.
Exp Clin Endocrinol Diabetes.
1998;
106
404-409
19
Reiber GE, Pecoraro RE, Koepsell TD.
Risk factors for amputation in patients with diabetes mellitus.
A case-control study. Ann Intern Med.
1992;
117
97-105
20
Mayfield JA, Reiber GE, Nelson RG. et al .
A foot risk classification system to predict diabetic amputation in Pima Indians.
Diabetes Care.
1996;
19
704-709
21
Flores Rivera AR.
Risk factors for amputation in diabetic patients: a case-control study.
Arch Med Res.
1998;
29
179-184
22
Eneroth M, Apelqvist J, Stenstrom A.
Clinical characteristics and outcome in 223 diabetic patients with deep foot infections.
Foot Ankle Int.
1997;
18
716-722
23
Winkley K, Stahl D, Chalder T. et al .
Risk factors associated with adverse outcomes in a population-based prospective cohort
study of people with their first diabetic foot ulcer.
J Diabetes Complications.
2007;
21
341-349
24
Faglia E, Clerici G, Clerissi J. et al .
Early and five-year amputation and survival rate of diabetic patients with critical
limb ischemia: data of a cohort study of 564 patients.
Eur J Vasc Endovasc Surg.
2006;
32
484-490
Correspondence
B. AkinciMD
Division of Endocrinology of Metabolism
Department of Internal Medicine
Dokuz Eylul University Medical School
Inciralti
Izmir
Turkey 35340
Phone: +90/232/412 37 44
Fax: +90/232/279 22 67
Email: baris.akinci@deu.edu.tr