This work from Rizzo and coworkers from Alberto Piaggesi’s unit at Pisa suggest that prevention can indeed pay.
The bottom line:
1, 3 and 5 year ulceration rate:
Standard Care: 39, 61, and 72% incidence of reulceration
Shoe group: 11, 17 and 25%
Custom-Made Orthoses and Shoes in a Structured Follow-Up Program Reduces the Incidence of Neuropathic Ulcers in High-Risk Diabetic Foot Patients
Loredana Rizzo, MD1, Anna Tedeschi, MD1, Eliana Fallani, OT1, Alberto Coppelli, MD1, Valerio Vallini, MD1, Elisabetta Iacopi, MD1, and Alberto Piaggesi, MD1
. The objective of this study was to assess the impact of a structured follow-up program on the incidence of diabetic foot ulceration (DFU) in high-risk diabetic patients. Research Design and Methods. A total of 1874 diabetic patients referred to the Diabetic Foot Unit of the University of Pisa were ranked based on the ulcerative risk score proposed by the International Consensus on Diabetic Foot. Out of 334 patients (17.8%) with a score ≥2, 298 accepted to participate in this prospective trial and were randomized into 2 groups: group A, which received standard treatment, and group B, in which the patients received, as a part of a structured prevention program, custom-made orthoses and shoes. Incidence of new DFUs was observed for no less than 1 year and in a subset of patients after 3 and 5 years, respectively. Incidence of new DFUs and recurrences were considered as primary endpoints to establish the effectiveness of the program; costs were also compared. Results. Among the patients enrolled in this follow-up analysis, 46% had neuropathy and deformities, 20% had previous ulceration, 25% had previous minor amputation, and 9% had neuro-osteoarthropathy. During the first 12-month follow-up, 11.5% of patients in group B developed a DFU compared with 38.6% in group A (P < .0001). In the extended follow-up, the cumulative incidence of ulcer in group B compared with group A was 17.6% versus 61% (P < .0001) after 3 years and 23.5% versus 72% (P < .0001) after 5 years, respectively.The net balance at the end of the follow-up was highly in favor of the prevention program, with a saving of more than €100 000 per year. Conclusions. The implementation of a structured follow-up with the use of orthoses and shoes can reduce the incidence of DFU in diabetic patients who are at high ulcerative risk and its related costs.
Int J Low Extrem Wounds. 2012 Mar;11(1):59-64. doi: 10.1177/1534734612438729. Epub 2012 Feb 15. Randomized Controlled Trial