Outcomes of preventative care in a diabetic foot specialty clinic.
The purpose of the study was to report the incidence of ulceration, reulceration, and amputation in 341 patients treated in a multidisciplinary clinic over the course of 3 years. Patients enrolled were 57.8% male, with a mean age of 53.2 +/- 11.8 years. All were assessed using the University of Texas Diabetic Foot Classification System. Of these patients, 118 fell into category 0 (protective sensation intact), 98 into category 1 (loss of protective sensation, LOPS), 77 into category 2 (LOPS with deformity), and 48 into category 3 (LOPS, deformity, previous history of ulcer or amputation). Outcomes assessed included any incident ulcerations or amputations. The authors stratified patients based on their compliance to follow up appointments. Non compliance was defined as missing > 50% of scheduled appointments in any calendar year. Thirty of the above subjects were classified as noncompliant. Prior to analysis, the authors initially stratified subjects into compliant and noncompliant groups. If further stratified by foot category, the incidence of ulceration in the compliant group was 0 for diabetic foot categories 0 and 1, 3.5/1,000/year for category 2, and 18/1,000/year for category 3. One category 3 patient required a partial first-ray amputation. The yearly incidence of amputation for the entire cohort was therefore 1.1/1,000/year. For categories 0-2 the incidence was 0, and for category 3, it was 9/1,000/year. Patients stratified into the noncompliant group were approximately 54 times more likely to ulcerate than patients who returned regularly for their scheduled care (81.8% ulcer prevalence vs. 5.4%, p < .0001, OR = 54.0, Cl = 7.5-1,425.0). Additionally, noncompliant category 3 patients were over 20 times more likely to receive an amputation than their compliant counterparts (45.5% amputation prevalence vs. 2.7%, p < .002, OR = 2.5-819.0). The study concluded that multidisciplinary diabetes care team, which includes aggressive foot care and consistent treatment-based risk classification, may be effective in profoundly mitigating the occurrence and recurrence of diabetic foot sequelae, including ulceration and amputation. Furthermore, patient noncompliance to routine preventative care appears to be associated with a significantly higher prevalence of ulceration and amputation.
Armstrong
D G
DG
Department of Orthopaedics, University of Texas Health Science Center at San Antonio 78284-7776, USA.
Harkless
L B
LB
D000554:Ambulatory Care Facilities; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D003663:Decision Trees; D017719:Diabetic Foot / Q000145:classification / Q000517:prevention & control* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010349:Patient Compliance; D012307:Risk Factors; D013781:Texas; D016896:Treatment Outcome