Adequacy of Clinical Surveillance of Diabetic Patients Requiring Minor Foot Amputations

NewsBot · Feb 3, 2022

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Adequacy of Clinical Surveillance of Diabetic Patients Requiring Minor Foot Amputations
A Retrospective Audit
Bernard Schembri, Martina Lia Falzon, Luca Casingena, Gabriel DeGiorgio, Mark Grech Sciberras, Michela Manfre, Kevin Cassar
MALTA MEDICAL JOURNAL VOL 34 NO 1 (2022)

Background: Minor amputations related to diabetic foot complications have become increasingly more frequent in Malta. International recommendations suggest a standardised follow-up for diabetic patients. We aim to compare the latter recommendations with a cohort of patients who underwent minor amputation in the years 2014-2017.

Methods: Data was collected retrospectively from 101 diabetic patients who were admitted to Mater dei Hospitalâ€™s Diabetic Foot Ward and required minor amputation. The audit parameters included patient demographics and specifics on the type of amputation, trending of relevant blood investigations prior to surgery and their follow-up history.

Results: A significant proportion of patients never had Hba1c (mean 4-year percentage of 34.4%), lipid (36.6%) or renal profile (23.3%) tested in the years leading to their amputations. Furthermore, the mean total Hba1c levels (9.36%) showed that these patients were mostly uncontrolled diabetics. A very large proportion of these patients were not seen at local health centres/diabetes outpatient clinics (65.3%). The majority had not been seen by a podiatrist (61.4%), nor received diabetes education (84.2%) and had not attended ophthalmic clinics (51.5%) in the years preceding their amputation.

Conclusion: Poor compliance with international guidelines for diabetic patients is likely to contribute to the high rate of minor amputations. A co-ordinated effort to improve compliance with international standards relating to diabetes care is urgently required.
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NewsBot · Sep 19, 2022

Impact of case-mix adjustment on observed variation in the healing of diabetic foot ulcers at 12 weeks using data from the National Diabetes Foot Care Audit of England and Wales: a cohort study
Arthur C Yelland et al
Diabet Med. 2022 Sep 17

Aim: This cohort study investigates the extent to which variation in ulcer healing between services can be explained by demographic and clinical characteristics.

Methods: The National Diabetes Foot Care Audit (NDFA) collated data on people with diabetic foot ulcers presenting to specialist services in England and Wales between July 2014 and March 2018. Logistic regression models were created to describe associations between risk factors and a person being alive and ulcer-free 12 weeks from presentation, and to investigate whether variation between 120 participating services persisted after risk factor adjustment.

Results: Of 27,030 people with valid outcome data, 12,925 (47.8%) were alive and ulcer-free at12 weeks, 13,745 (50.9%) had an unhealed ulcer and 360 had died (1.3%). Factors associated with worse outcome were male sex, more severe ulcers, history of cardiac or renal disease and a longer time between first presentation to a non-specialist healthcare professional and first expert assessment. After adjustment for these factors, four services (3.3%) were more than 3SD above and seven services (5.8%) were more than 3SD below the national mean for proportions that were alive and ulcer-free at follow-up.

Conclusions/interpretations: Variation in the healing of diabetic foot ulcers between specialist services in England and Wales persisted after adjusting for demographic characteristics, ulcer severity, smoking, body mass index and co-morbidities. We conclude that other factors contribute to variation in healing of diabetic foot ulcers and include the time to specialist assessment.
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