Senescent Diabetic Foot Disease: Upstream comprehensive management of individuals with diabetes with multimorbidity and frailty to #ActAgainstAmputation #DiabeticFoot @ALPSlimb @USC @USC_vascular @ResearchatUSC @KeckSchool_USC @VirginiePhD_POD @AeroMD

This manuscript from our combined Quebec/ Palermo / USC family.

Virginie Blanchette, David G. Armstrong, Laura Drudi and Manfredi Rizzo

This manuscript constitutes a commentary on: “Retrospective cohort study of long-term outcomes and prognostic factors for survival after lower extremity amputation in patients with diabetes” by Vuorlaakso et al. (2023). We aim to contribute to the reflection of their findings to support the comprehensive management of vulnerable individuals with multimorbidity and/frailty for limb preservation. There is an urgent need to understand the effects of frailty on overall survival after amputation, survival without major amputation, and the effect modification with multimorbidity.

“Finally, the interaction between CKD, ageing, and frailty has been termed “senescent nephropathy” a condition characterized by a synergistic decline of functions.25 Can we therefore hypothesize a condition termed “senescent diabetic foot disease” that includes a relationship between frailty (especially advanced age), CKD and other multimorbidities such as PAD? This condition could be illustrated by the synergy of the additive effects of the DRFC triads leading to reduced OS (Fig. 1).”

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