title: Reducing major lower extremity amputations after the introduction of a multidisciplinary team in patient with diabetes foot ulcer.
abstract: BACKGROUND
  Diabetic foot ulceration is receiving more attention because of its high amputation and mortality rate. It is essential to establish the frequency of amputations in people with diabetes after any change to the management of diabetic foot care. The present study aim to compare the frequency of lower-extremity amputations in patients with diabetes foot ulcer over a ten-year period.
  
  
  METHODS
  Six hundred forty eight patients with diabetes foot ulcer were retrospectively studied from 2004 to 2013. The clinical features, laboratory results and the lower-extremity amputations were recorded. Major amputation was defined as amputations above the ankle while minor amputation was amputations below the ankle in the present study.
  
  
  RESULTS
  Patients with diabetic foot ulcer were old (age 66.96 ± 11.96 years), with a long duration of diabetes (10.30 ± 6.94 years), high HbA1c (9.19 ± 2.62 %), SBP (144.05 ± 24.18 mmHg), DBP (79.53 ± 11.88 mmHg), LDL-C (2.71 ± 0.93 mmol/L) and had great frequency of neuropathy (62.7 %), retinopathy (45.0 %), nephropathy (39.5 %) and PAD (33.2 %). From 2004 to 2013, the frequency of all lower-extremity amputations is 12.0 % (5.2 % major amputation, 6.8 % minor amputation). The frequency of major amputations decreased from 9.5 % in 2004 and 14.5 % in 2005 to less than 5.0 % after 2006. In particular, there was a significant decline in major amputations of diabetic foot patient with Wagner 3 to 4 wounds. The frequency rate of major amputations in diabetic foot patient with Wagner 3 to 4 wounds fell from 35.7 % in 2004 to 4.4 % after 2007. The change in frequency of minor amputations was fluctuation.
  
  
  CONCLUSIONS
  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 frequency of major amputations in patients with diabetes.
authors.affiliation: Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
authors.forename: Chuan
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
authors.forename: Lifang
authors.initials: L
authors.lastname: Mai
authors.affiliation: Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
authors.forename: Chuan
authors.initials: C
authors.lastname: Yang
authors.affiliation: Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
authors.forename: Kan
authors.initials: K
authors.lastname: Sun
authors.affiliation: Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
authors.forename: Weidong
authors.initials: W
authors.lastname: Song
authors.affiliation: Department of Ultrasonography, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
authors.forename: Baoming
authors.initials: B
authors.lastname: Luo
authors.affiliation: Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
authors.forename: Mingtong
authors.initials: M
authors.lastname: Xu
authors.affiliation: Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
authors.forename: Shaoling
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
authors.forename: Fangping
authors.initials: F
authors.lastname: Li
authors.affiliation: Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Ren
authors.affiliation: Department of Endocrinology and Metabolism, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China. hfxyl@163.net.
authors.forename: Li
authors.initials: L
authors.lastname: Yan
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D017719:Diabetic Foot / Q000628:therapy*; D006801:Humans; D007400:Interprofessional Relations; D010348:Patient Care Team; D011379:Prognosis; D015397:Program Evaluation; D011787:Quality of Health Care; D012189:Retrospective Studies
keywords: Amputation; Diabetes foot; Ulcer