title: The development and application of diabetic foot protocol in Chiang Mai University Hospital with an aim to reduce lower extremity amputation in Thai population: a preliminary communication.
abstract: Lower extremity amputation is a frequent complication of diabetes, and the authors' region did not have effective strategies to minimize it. From August 2005 to July 2006, a diabetic foot protocol (DFP) for out-patient management based on a multidisciplinary team approach was tried at the local teaching hospital. There are devices to reduce pressure and educate. After healing, there are custom fabricated orthoses and footwear, and monitoring of progressive ambulation. This report compares the amputation rate in patients receiving DFP care from August 2005 to July 2006 with those who had standard care from August 2003 to July 2005. Sixty-one and 110 diabetic foot ulcer patients received DFP and standard foot care, respectively. Their sex distribution and mean age were similar. The incidence of major amputations in the DFP and standard care groups was 3.3% and 13.6%, respectively (P = .03). The incidence of minor amputations in the DFP and standard care groups was 3.4% and 15.8%, respectively (P = .02). DFP was associated with improved diabetic foot care outcomes. It may be used by clinical teams with a view to improve outcomes for patients with diabetes.
authors.affiliation: Department of Surgery, Chiang Mai University, Chiang Mai, Thailand. krerkase@mail.med.cmu
authors.forename: K
authors.initials: K
authors.lastname: Rerkasem
authors.forename: N
authors.initials: N
authors.lastname: Kosachunhanun
authors.forename: S
authors.initials: S
authors.lastname: Tongprasert
authors.forename: K
authors.initials: K
authors.lastname: Khwanngern
authors.forename: A
authors.initials: A
authors.lastname: Matanasarawoot
authors.forename: C
authors.initials: C
authors.lastname: Thongchai
authors.forename: K
authors.initials: K
authors.lastname: Chimplee
authors.forename: S
authors.initials: S
authors.lastname: Buranapin
authors.forename: S
authors.initials: S
authors.lastname: Chaisrisawadisuk
authors.forename: A
authors.initials: A
authors.lastname: Manklabruks
mesh_terms: D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D017719:Diabetic Foot / Q000150:complications / Q000601:surgery / Q000628:therapy*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012775:Shoes; D013785:Thailand; D014945:Wound Healing