Structured health care for subjects with diabetic foot ulcers results in a major reduction of amputation rates

Structured health care for subjects with diabetic foot ulcers results in a major reduction of amputation rates:

This manuscript from Weck and coworkers suggests a 75% reduction in amputation rates and a near four-fold reduction in inpatient mortality by instituting a structured diabetic foot program for people with wounds.

ObjectiveWe tested the effects of structured health care for the diabetic foot in one region in Germany aiming to reduce the number of major amputations.Research design and methods: In a prospective study we investigated patients with diabetic foot in a structured system of outpatient, in-patient and rehabilitative treatment. Subjects were recruited between January 1st, 2000 and December 31, 2007.

All participants underwent a two-year follow-up. The modified University of Texas Wound Classification System (UT) was the basis for documentation and data analysis.

We evaluated numbers of major amputations, rates of ulcer healing and mortality. In order to compare the effect of the structured health care program with usual care in patients with diabetic foot we evaluated the same parameters at another regional hospital without interdisciplinary care of diabetic foot (controls). 

Results: 684 patients with diabetic foot and 508 controls were investigated.

At discharge from hospital 28.3% (structured health care program, SHC) vs. 23.0% (controls) of all ulcers had healed completely.

51.5% (SHC) vs. 49.8% (controls) were in UT grade 1.Major amputations were performed in 32 subjects of the structured health care program group (4.7%) vs.

110 (21.7%) in controls (p
9.4% in controls (p

Conclusions: With the structured health care program we achieved a significant reduction of major amputation rates by more than 75% as compared to standard care.

Author: Matthias WeckTorsten SlesaczeckHartmut PaetzoldDirk MuenchThomas NanningGeorg GagernAndrej BrechowUlf DietrichMandy HolfertStefan BornsteinAndreas BarthelAntje ThomasMarkolf HanefeldCarsta Koehler
Credits/Source: Cardiovascular Diabetology 2013