This was just presented by our team at the American Diabetes Association annual symposium. We’re thrilled that Tze Woei Tan, lead author, was awarded the Marvin Levin Award for top abstract in its category. The study, the first of its kind, evaluated more than 50,000 patients. Those that received podiatric care prior to developing a diabetic foot ulcer were approximately 18% less likely to die or have an amputation over four years of study follow-up.
Association between Preventive Podiatric Care and Outcomes of New Diabetic Foot Ulceration among Patients with End Stage Renal Disease
Objective: To assess the association between foot care by podiatric surgeons and outcomes of new diabetic foot ulceration (DFU) among patients with end-stage renal disease (ESRD) .
Methods: We used the 2015 and 2016 claim data from the United States Renal Data System to identify patients (≥ 40 years and on dialysis for ≥ 12 months) with a new diagnosis of DFU. The patients were stratified into intervention or control cohort based on whether they received any foot care by a podiatric surgeon within 12 months before the diagnosis of a new DFU. Patients were followed from the index DFU date until December 31, 2018. The study outcome was amputation-free survival (composite endpoint of mortality and major amputation) . Adjusted comparisons between preventive foot care and its association with outcomes were performed by Cox-regression analysis after propensity score matching for age, gender, race, hospitalizations, and Charlson Comorbidity Index (CCI) .
Results: Among the 51,362 ESRD patients included, 16,156 (31.5%) received podiatric care within 12 months before their index DFU. Compared to the control cohort, the intervention cohort was older, likely to be female (44% vs. 39%) , and more likely to have peripheral artery disease (64.2% vs. 49.5%) . The overall major amputation rate was 9.6% during study follow-up (intervention: 9.3% vs. control: 9.8%) . A Kaplan-Meier estimate indicated that foot care before index DFU was associated with increased amputation-free survival based on the Log Rank test (p<0.0001) . In addition, the multivariable analysis demonstrated that foot care prior to index DFU was associated with a lower risk of death or major amputation in both the unmatched (Hazard ratio [HR] 0.92, 95% Confidence Interval [CI] 0.90, 0.93, p<0.0001) and matched cohorts (HR 0.82, 95% CI 0.79, 0.85, p<0.0001) .
Conclusion: Among patients with end stage renal disease, preventive podiatric care appears to improve amputation-free survival for DFU.