The study titled “Multi-disciplinary diabetic limb salvage programme in octogenarians with diabetic foot ulcers is not futile: An observational study with historical controls” by Lixia Ge, Jiashen Zhao, Matthew Tan, Elaine Tan, Huiling Liew, Enming Yong, Jeremy Hoe, Claris Shi, Dexter Yak Seng Chan, Gary Yee Ang, Joseph Antonio Molina, Yan Sun, Wai Han Hoi, Sadhana Chandraskear, and Zhiwen Joseph Lo, evaluates the effectiveness of a multi-disciplinary diabetic limb salvage (DLS) programme in improving clinical outcomes and optimizing healthcare utilization in patients aged 80 years and above with diabetic foot ulcers (DFUs), compared to younger patients and historical controls. The study was conducted within the Health Services and Outcomes Research department of the National Healthcare Group in Singapore, among other institutions.
The research encompassed 406 octogenarian patients with DFUs enrolled in the DLS programme from June 2020 to July 2021, 2392 younger patients with DFUs enrolled during the same timeframe, and 1718 historical control patients aged 80 years and above diagnosed with DFUs and received usual care between June 2016 and December 2017. The study aimed to assess the average treatment effect (ATE) of the DLS programme in reducing major lower extremity amputations (LEAs) among DFU patients aged 80 years and above.
Key findings include that elderly programme patients had lower odds of amputation-free survival and shorter cumulative length of stay compared to younger programme patients. Compared to matched controls, participation in the programme was associated with a 5% higher probability of minor lower extremity amputation, reduced inpatient admissions and emergency visits, shorter length of stay but increased specialist and primary care visits. The study suggests that the DLS programme yielded favorable impacts on the clinical outcomes of patients aged 80 years and above with DFUs, highlighting the need for specific interventions tailored to the elderly population.
The study was funded by the Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR), the National Healthcare Group, and the National Medical Research Council. The authors declare no financial relationships or conflicts of interest, and data availability is restricted due to legal and ethical considerations but can be requested with authorization from the ethical committee of the National Health Group Domain Specific Review Board.
This intriguing study contributes valuable insights into the management of DFUs in the elderly, emphasizing the effectiveness of a multi-disciplinary approach in improving patient outcomes and healthcare utilization.
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