title: The system of care for the diabetic foot: objectives, outcomes, and opportunities.
abstract: Most cases of lower extremity limb loss in the United States occur among people with diabetes who have a diabetic foot ulcer (DFU). These DFUs and the associated limb loss that may occur lead to excess healthcare costs and have a large negative impact on mobility, psychosocial well-being, and quality of life. The strategies for DFU prevention and management are evolving, but the implementation of these prevention and management strategies remains challenging. Barriers to implementation include poor access to primary medical care; patient beliefs and lack of adherence to medical advice; delays in DFU recognition; limited healthcare resources and practice heterogeneity of specialists. Herein, we review the contemporary outcomes of DFU prevention and management to provide a framework for prioritizing quality improvement efforts within a resource-limited healthcare environment.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine/Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
authors.forename: Neal R
authors.initials: NR
authors.lastname: Barshes
authors.forename: Meena
authors.initials: M
authors.lastname: Sigireddi
authors.forename: James S
authors.initials: JS
authors.lastname: Wrobel
authors.forename: Archana
authors.initials: A
authors.lastname: Mahankali
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Robbins
authors.forename: Panos
authors.initials: P
authors.lastname: Kougias
authors.forename: David G
authors.initials: DG
authors.lastname: Armstrong
keywords: delivery of healthcare; diabetes; diabetic neuropathy; foot ulcer; peripheral vascular disease; physician's practice patterns