Endocrine Abstracts

JOINT347

Introduction and Objectives: Diabetes mellitus-related foot disease is one of the most serious complications of DM with loss of quality of life and high economic cost. Peripheral arterial disease is present in > 50% of patients and infection affects 60% ulcers (main cause of amputation). The risk of death in 5 years for a patient with an ulcer is 2-5 times higher.

Material and Method: We performed a descriptive of the patients treated in our diabetic foot clinic during one year (September 2023-2024), including patient profile, risk factors, complications, history of amputation, pathophysiology, treatment and evolution to propose improvement options.

Results: 97 new patients. From Primary Care, Emergency, Infectious Diseases, Internal Medicine, CCV or Endocrinology. Complex cases presented to the committee (endocrinology, infectious diseases, rehabilitation, trauma, CCV, radiology). Our patient profile: mean age 66.7 years, male (74%), diabetes 2 88% (8 patients type 1), long history (mean 19 years) and poor metabolic control (mean HbA1c 7.8%), hypertensive (76%), dyslipidemia (89%) and smokers (59%). Complications: retinopathy (58%), nephropathy (42%), stroke (15%) and heart disease (19%). Polyneuropathy 76% and arteriopathy 76% patients. Most combine both. History of previous ulcer (63%) and previous amputation (37%). Patients with isglt2 (54%): (empagliflozin 30%, dapagliflozin 23%, canagliflozin 0%). 55.6% of the total (54 patients) had active ulcer. 43 high-risk patients who no longer had ulcers. Type of ulcer: ischemic 35.2%/neuropathic 14.8%/neuroischemic 50%. 2 classifications indicating ulcer severity and longer healing time, SINBAD and PEDIS. SINBAD score > or equal to 3 (32 patients), PEDIS 3 (17 patients) and PEDIS 4 (2 patients). Infection (23 patients). 24 patients required admission, Infectious Diseases or Traumatology, due to complicated ulcer or scheduled admission CCV (preferential angioplasty). All cases require education or care by specialized nursing. Most require angioplasty: - Dressing and antibiotic therapy: 8 patients - Antibiotic therapy, debridement and angioplasty: 16 patients - Debridement and angioplasty: 16 patients At the time of cutting, 32% closed ulcer, healing time (2-32 weeks). Amputation was required due to poor evolution; 7 minor amputations and 4 major ones. One patient died due to a cause unrelated to diabetic foot. In the subgroup with iSGLT2, some amputations were not under treatment, so there is no clear association. We should use them whenever they are indicated due to “high CV risk”.

Conclusion: It is important to have a multidisciplinary team and preferential care consultations, in order to reduce mortality.