title: Reducing major lower extremity amputations after the introduction of a multidisciplinary team for the diabetic foot.
abstract: We analyzed the incidence of lower extremity amputations (LEAs) in the 3rd Health Care Area of Madrid before and after the March 2008 introduction of a multidisciplinary team for managing diabetic foot disease. We compared the amputation rates in people with and without diabetes during 2 periods: before (2001-2007) and after (2008-2011) the introduction of a Multidisciplinary Diabetic Foot Unit (MDFU). We also analyzed the trend of the amputation rates by joinpoint regression analysis and measured the annual percentage change (APC). During the study period, 514 nontraumatic LEAs were performed, 374 (73%) in people with diabetes and 140 (27%) in people without the disease. The incidence of LEAs showed a significant reduction in major amputations in people with diabetes, from 6.1 per 100 000 per year (95% confidence interval [CI] = 4.9 to 7.2), in the 2001 to 2007 period, to 4.0 per 100 000 per year (95% CI = 2.6 to 5.5) in the 2008 to 2011 period (P = .020). There were no changes in incidence of minor or total amputations in the diabetic population or in amputations in the nondiabetic population during the study period. Joinpoint regression analysis showed a significant reduction in the incidence of major LEAs in diabetic population with an APC of -6.6% (95% CI = -10.2 to -2.8; P = .003), but there were no other significant changes. This study demonstrates that the introduction of a multidisciplinary team, coordinated by an endocrinologist and a podiatrist, for managing diabetic foot disease is associated with a reduction in the incidence of major amputations in patients with diabetes.
authors.affiliation: 1Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Rubio
authors.forename: Javier
authors.initials: J
authors.lastname: Aragón-Sánchez
authors.forename: Sara
authors.initials: S
authors.lastname: Jiménez
authors.forename: Gregorio
authors.initials: G
authors.lastname: Guadalix
authors.forename: Agustín
authors.initials: A
authors.lastname: Albarracín
authors.forename: Carmen
authors.initials: C
authors.lastname: Salido
authors.forename: José
authors.initials: J
authors.lastname: Sanz-Moreno
authors.forename: Fernando
authors.initials: F
authors.lastname: Ruiz-Grande
authors.forename: Nuria
authors.initials: N
authors.lastname: Gil-Fournier
authors.forename: Julia
authors.initials: J
authors.lastname: Álvarez
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000639:trends*; D017719:Diabetic Foot / Q000453:epidemiology / Q000601:surgery*; D004704:Endocrinology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D033183:Interdisciplinary Communication; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D009985:Orthopedics; D010348:Patient Care Team; D011032:Podiatry; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology
keywords: diabetic foot; diabetic foot clinic; foot ulcer; lower extremity amputation; multidisciplinary team