title: Does contact with a podiatrist prevent the occurrence of a lower extremity amputation in people with diabetes? A systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine the effect of contact with a podiatrist on the occurrence of Lower Extremity Amputation (LEA) in people with diabetes.
  
  
  METHODS
  We conducted a systematic review of available literature on the effect of contact with a podiatrist on the risk of LEA in people with diabetes. Eligible studies, published in English, were identified through searches of PubMed, CINAHL, EMBASE and Cochrane databases. The key terms, 'podiatry', 'amputation' and 'diabetes', were searched as Medical Subject Heading terms. Reference lists of selected papers were hand-searched for additional articles. No date restrictions were imposed.
  
  
  METHODS
  Published randomised and analytical observational studies of the effect of contact with a podiatrist on the risk of LEA in people with diabetes were included. Cross-sectional studies, review articles, chart reviews and case series were excluded. Two reviewers independently assessed titles, abstracts and full articles to identify eligible studies and extracted data related to the study design, characteristics of participants, interventions, outcomes, control for confounding factors and risk estimates.
  
  
  METHODS
  Meta-analysis was performed separately for randomised and non-randomised studies. Relative risks (RRs) with 95% CIs were estimated with fixed and random effects models as appropriate.
  
  
  RESULTS
  Six studies met the inclusion criteria and five provided data included in meta-analysis. The identified studies were heterogenous in design and included people with diabetes at both low and high risk of amputation. Contact with a podiatrist did not significantly affect the RR of LEA in a meta-analysis of available data from randomised controlled trials (RCTs); (1.41, 95% CI 0.20 to 9.78, 2 RCTs) or from cohort studies; (0.73, 95% CI 0.39 to 1.33, 3 Cohort studies with four substudies in one cohort).
  
  
  CONCLUSIONS
  There are very limited data available on the effect of contact with a podiatrist on the risk of LEA in people with diabetes.
authors: Department of General Practice, University College Cork, Cork, Ireland.
authors: C M
authors: CM
authors: Buckley
authors: I J
authors: IJ
authors: Perry
authors: C P
authors: CP
authors: Bradley
authors: P M
authors: PM
authors: Kearney
keywords: Vascular surgery
references: J Am Podiatr Med Assoc. 2002 Sep;92(8):425-8
references: 12237262
references: BMJ. 2009 Jul 21;339:b2700
references: 19622552
references: Diabetes Care. 2000 Sep;23(9):1339-42
references: 10977029
references: Curr Opin Endocrinol Diabetes Obes. 2012 Apr;19(2):93-6
references: 22262000
references: Cochrane Database Syst Rev. 2012 Oct 17;10:CD001488
references: 23076893
references: Int J Clin Pract. 2006 Jun;60(6):667-9
references: 16805750
references: Diabetes Metab Res Rev. 2000 Sep-Oct;16 Suppl 1:S75-83
references: 11054894
references: Health Serv Res. 2010 Dec;45(6 Pt 1):1740-62
references: 20722748
references: Diabetes Care. 2003 Jun;26(6):1691-5
references: 12766095
references: Int J Epidemiol. 2011 Jun;40(3):804-18
references: 21335614
references: Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007610
references: 20091642
references: Diabetes Care. 1990 May;13(5):513-21
references: 2351029
references: Perit Dial Int. 2003 May-Jun;23(3):255-9
references: 12938826
references: Diabet Med. 1998;15 Suppl 4:S57-9
references: 9868994
references: Lancet. 1998 Sep 12;352(9131):837-53
references: 9742976
references: Res Synth Methods. 2010 Apr;1(2):149-61
references: 26061380
references: J Epidemiol Community Health. 1998 Jun;52(6):377-84
references: 9764259
references: Diabetes Care. 2010 Jul;33(7):1460-2
references: 20424223
references: Diabetes Care. 1997 Dec;20(12):1833-7
references: 9405902
references: Diabetes Care. 1999 May;22(5):678-83
references: 10332665
references: Int J Epidemiol. 2006 Apr;35(2):337-44
references: 16368725
references: Diabetes Care. 2008 Aug;31(8):1679-85
references: 18663232
references: JAMA. 2005 Jan 12;293(2):217-28
references: 15644549
references: Scand J Soc Med. 1993 Mar;21(1):40-50
references: 8469943
references: Diabetologia. 2010 May;53(5):840-9
references: 20127309
references: Diabetes Care. 1999 Jul;22(7):1029-35
references: 10388962
references: Diabet Med. 1995 Sep;12(9):770-6
references: 8542736
references: Soc Sci Med. 2003 Sep;57(5):895-904
references: 12850114
references: J Am Podiatr Med Assoc. 1999 Jun;89(6):312-7
references: 10384758
references: Diabet Med. 2011 Oct;28(10):1144-53
references: 21388445
references: J Am Podiatr Med Assoc. 1997 Jul;87(7):305-12
references: 9241972
references: BMJ. 1998 Sep 12;317(7160):703-13
references: 9732337
references: Diabetes Care. 1999 Sep;22(9):1428-31
references: 10480504
references: BMJ. 2003 Sep 6;327(7414):557-60
references: 12958120