Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale Study, a prospective cohort study.
OBJECTIVE
To determine current management and to identify patient-related factors and barriers that influence management strategies in diabetic foot disease.


METHODS
The Eurodiale Study is a prospective cohort study of 1232 consecutive individuals presenting with a new diabetic foot ulcer in 14 centres across Europe. We determined the use of management strategies: referral, use of offloading, vascular imaging and revascularization.


RESULTS
Twenty-seven percent of the patients had been treated for > 3 months before referral to a foot clinic. This varied considerably between countries (6-55%). At study entry, 77% of the patients had no or inadequate offloading. During follow-up, casting was used in 35% (0-68%) of the plantar fore- or midfoot ulcers. Predictors of use of casting were male gender, large ulcer size and being employed. Vascular imaging was performed in 56% (14-86%) of patients with severe limb ischaemia; revascularization was performed in 43%. Predictors of use of vascular imaging were the presence of infection and ischaemic rest pain.


CONCLUSIONS
Treatment of many patients is not in line with current guidelines and there are large differences between countries and centres. Our data suggest that current guidelines are too general and that healthcare organizational barriers and personal beliefs result in underuse of recommended therapies. Action should be undertaken to overcome these barriers and to guarantee the delivery of optimal care for the many individuals with diabetic foot disease.
Division of Endocrinology, Department of Internal Medicine, University Hospital Maastricht, Maastricht, the Netherlands. leonne.prompers@intmed.unimaas.nl
L
L
Prompers
M
M
Huijberts
J
J
Apelqvist
E
E
Jude
A
A
Piaggesi
K
K
Bakker
M
M
Edmonds
P
P
Holstein
A
A
Jirkovska
D
D
Mauricio
G R
GR
Tennvall
H
H
Reike
M
M
Spraul
L
L
Uccioli
V
V
Urbancic
K
K
Van Acker
J
J
Van Baal
F
F
Van Merode
N
N
Schaper
D000553:Ambulatory Care / Q000592:standards / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000592:standards*; D017719:Diabetic Foot / Q000628:therapy*; D004812:Epidemiologic Methods; D005060:Europe; D005260:Female; D006801:Humans; D007511:Ischemia / Q000628:therapy; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D015424:Reperfusion / Q000706:statistics & numerical data