Objective: This study reviews the clinical characteristics of patients treated in a Multidisciplinary Diabetic Foot Unit (MDFU) and analyzes the rate of diabetic foot amputations and the risk factors associated.
Design and methods: A retrospective cohort study including data from all patients who attended the MDFU during December 2017-October 2018 period. The patients were followed until January 2019. Clinical, anthropometric, and biochemical parameters (HbA1c, LDL-c) were determined. A descriptive analysis, cumulative incidence of foot amputations, and a correlation analysis (significance <0.05) was performed.
Results: A total of 118 subjects with a median age of 65±11 years were included. Of these, 77% were males and 93% had type 2 diabetes mellitus (diabetes evolution time 19±11 years). 52% of patients were in secondary prevention (of these, 41% had history of lower-extremity amputation). Clinical form: at-risk foot (without pre-ulcerative signs) 40.7%, neuropathic ulcer 20.4%, neuro-ischemic ulcer 14.8%, infected foot 13%, neuropathic arthropathy 3.7%, and risk-free foot 7.4%. The severity of foot ulcers according to the Wagners ulcer classification scale was: grade 1, 22%; grade 2, 5%; grade 3, 13%; grade 4, 2%; and grade 5, 1%. Subjects were characterized as patients with high prevalence of chronic complications: sensory neuropathy 77%, retinopathy 46%, peripheral artery disease 46%, nephropathy 30%, ischemic heart disease 25%, and cerebrovascular disease 16%. Mean values of the biochemical and anthropometric parameters: HbA1c 8%±2, LDL-c 110 mg/dl±38, BMI 30 kg/m2±5. The average time follow-up was 9.4±4 months. Incidence of foot amputations was 14% (25% major amputation); 63% occurred in patients with history of lower-extremity amputation. Median time to the amputation was 6±5 months. Correlation analysis showed retinopathy (P=0.04), peripheral artery disease (P=0.002), sensory neuropathy (P=0.086), smoking (P=0.01) and alcoholism (P=0.03) to be factors related to foot amputation; but not glycosuric drugs (28 subjects, P=0.6). HbA1c value showed a reduction in 1.7% (P=0.01) at the end of the follow-up.
Conclusions: Patients attended in MDFU are characterized by high morbidity with secondary prevention being the most frequent cause of medical care. Retinopathy, peripheral artery disease, sensory neuropathy, smoking and alcoholism were factors related to foot amputation incidence. Primary prevention should be a priority in MDFU. It is necessary to implement a new preventive comprehensive foot care program.
18 - 21 May 2019
European Society of Endocrinology