Our friends and colleagues at the Universidad Complutense de Madrid—led by Mateo López-Moral, Marta García-Madrid, Esther García-Morales, Yolanda García-Álvarez, Francisco J. Álvaro-Afonso, and José Luis Lázaro-Martínez—have just published the DIATIME Comparative Efficacy Study, a randomized clinical trial that may help redefine how often we should see patients in remission after a healed diabetic foot ulcerLópez-Moral et al. 2025 – Compa….
📊 Study at a Glance
This single-center, randomized controlled trial enrolled 148 people with diabetes in remission (IWGDF risk 3) following a healed plantar ulcer. Participants were allocated to podiatric screening and callus debridement every 4, 8, or 12 weeks and followed for one yearLópez-Moral et al. 2025 – Compa….
All participants used therapeutic footwear with rocker-soled shoes and custom insoles, and each visit included comprehensive nail and callus care.
🦶 Key Findings
- Recurrence rates differed dramatically by interval:
- 4-week group: 18.4%
- 8-week group: 28.6%
- 12-week group: 46% (P < 0.001)
- Kaplan-Meier survival curves showed significantly longer ulcer-free survival in the 4-week group (mean 309 days) compared with 189 days in the 12-week group.
- The number needed to treat (NNT) to prevent one recurrence at 12 months was 6.6.
- Minor amputations occurred more frequently in the 12-week group (12%) than in the 4-week group (2%).
Importantly, no deaths or major amputations occurred during the study periodLópez-Moral et al. 2025 – Compa….
🩺 Why This Matters
While current IWGDF and ADA guidelines recommend screening every 1–3 months, this is largely based on expert opinion rather than comparative data. DIATIME fills that evidence gap—demonstrating that monthly podiatric follow-up reduces recurrence and delays lesion onset compared to longer intervals.
Mechanistically, the authors note that callus accumulation and rising plantar pressures begin within 4–8 weeks, with minor lesions appearing before frank ulceration. Frequent care interrupts this cycle of pressure, inflammation, and recurrence.
💡 Practical Takeaway
For patients in remission—especially those with prior plantar forefoot ulcers—a 4-week foot care interval may be the sweet spot. As Lázaro-Martínez and colleagues point out, the first 90 days after healing represent a high-risk window; consistent follow-up during this period may prevent the majority of recurrences.
🤝 Looking Ahead
The study reinforces what many of us see daily in clinic: “remission is not resolution.” Sustained, structured care remains central to limb preservation. Future cost-effectiveness work and integration of remote monitoring could help extend these benefits beyond specialized centers.
Citation:
López-Moral M, García-Madrid M, García-Morales E, García-Álvarez Y, Álvaro-Afonso FJ, Lázaro-Martínez JL. “Comparison of 4, 8, and 12-week screening and foot care frequencies in persons in remission: The DIATIME comparative efficacy study – A randomized clinical trial.” Diabetes Research and Clinical Practice. 2025;112962. DOI: 10.1016/j.diabres.2025.112962.
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