Podiatric care from diabetologists point of view
Authors:
Vladimíra Fejfarová 1,3; Miroslav Koliba 5; Jarmila Jirkovská 4; Hana Kůsová 6; Pavlína Piťhová 3; Alexandra Jirkovská 7; Bedřich Sixta-členové Podiatrické Sekce Čds Čls Jep 2; Marcela Szabo 8
Authors place of work:
Centrum diabetologie, IKEM, Praha
1; Klinika transplantační chirurgie, IKEM, Praha
2; Interní klinika 2. LF UK a FN Motol, Praha
3; Diabetologické centrum, Interní klinika 1. LF UK a ÚVN, Praha
4; Interní a kardiologická klinika FN Ostrava, LF Ostravská univerzita
5; 1. Interní klinika, Fakultní nemocnice Plzeň
6; Fakultní Thomayerova nemocnice, Praha
7; Poliklinika Barrandov, Praha
8
Published in the journal:
Vnitř Lék 2022; 68(E-7): 3-10
Category:
Original Contributions
doi:
https://doi.org/10.36290/vnl.2022.099
Summary
Scoring for the risk of Diabetic foot syndrome (DFS) should be performed regularly in each patient with diabetes mellitus (DM). Patients at risk for DFS should be followed by diabetologists, those with moderate and severe risk for the development of DFS or those with DFS in remission should be already followed by podiatrists. The aim of our study was to determine the extent of DFS risk screening procedures, dispensary care of patients at risk for DFS and treatment of patients with newly developed DFS in diabetes clinics in the Czech Republic.
Methods: To find out the study data, we prepared in cooperation with the ČDS ČLS JEP Committee a questionnaire survey for outpatient diabetology specialists.
Results: The questionnaire was completed by 57% (76/135) of diabetologists. Most of them dispensary approximately 1000- 2000 patients with DM. Their feet are checked by 98.7% of diabetologists (1.6 ± 0.8 times a year on average). Screening for the risk of DFS (13024) is performing in less than 100 patients by 74.3% of diabetologists, in 100–200 patients by 14.9% and in more than 200 patients by 10.8% of diabetologists. 77% of respondents are able to examine neuropathy, the rest send their patients to neurologists, peripheral arterial disease is evaluated by only 47.3% of diabetologists (35.3% of them use some form of instrumental examination), others (48.6%) send patients to angiologists, 4.1% of diabetologists do not examine PAD at all). Based on the assessed findings, more than half of the respondents (50.7%) perform scoring for the risk of DFS, but 1/5 of outpatient diabetologists do not know how the scoring is performed. If colleagues find a patient at a risk for DFS, they usually follow him/her by themselves (64.4%), in 24.6% of cases they send the patient immediately to podiatry or surgery (11%). If a patient with a new DFS comes at diabetology clinic, 72.6% of diabetologists are able to prescribe off-loading, 60.3% antibiotics, 47.9% local therapy. Only 52.1% of diabetologists send a patient with a new DFS to outpatient foot clinic, 39.7% to surgery, the rest of them elsewhere.
Conclusion: Based on the questionnaire survey results, the screening of DFS is currently severely undersized in outpatient diabetology clinics, it is sufficiently performed only by 11% of diabetologists. Only 16% of diabetologists perform some form of non-invasive diagnostic procedures detecting peripheral arterial disease, neuropathy examinations are more common. If a diabetologist meet a patient with newly developed DFS, he/she is able to prescribe off-loading or antibiotics, but only half of the diabetologists send the patient to outpatient foot clinic, probably due to a lack of them or their overload.
Keywords:
prevention – diabetic foot syndrome – podiatric care
Zdroje
1. Fejfarová V, Piťhová P, Koliba M, Jirkovská A, Jirkovská J, Kůsová H, Sixta B. Syndrom diabetické nohy, kam s ním. Česká diabetologie. 2021;4:3-6.
2. Sollitto RJ, Gazivoda PL, Hart TJ. Diabetic foot amputations. Part II: Metatarsal amputations. J Foot Surg. 1990;29(2):135-40. PMID: 2338472.
3. Troisi N, Ercolini L, Chisci E, Baggiore C, Chechi T, Manetti F, Del Pin B, Virgili R, Lepri GA, Landini G, Michelagnoli S. Diabetic Foot Infection: Preliminary Results of a Fast‑Track Program with Early Endovascular Revascularization and Local Surgical Treatment. Ann Vasc Surg. 2016;30:286-91. doi: 10.1016/j.avsg.2015. 07. 015. Epub 2015 Sep 11. PMID: 26370745.
4. Meloni M, Izzo V, Manu C, Ahluwalia R, Pedro J, Sánchez‑Ríos CL. Fast‑track pathway: an easy‑to‑use tool to reduce delayed referral and amputations in diabetic patients with foot ulceration. Diab Foot J. 2019;22(2).
5. Schaper NC, van Netten JJ, Apelqvist J, Bus SA, Hinchliffe RJ, Lipsky BA; IWGDF Editorial Board. Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev. 2020r;36 Suppl 1:e3266. doi: 10.1002/ dmrr.3266. PMID: 32176447.
6. Edmonds ME, Blundell MP, Morris ME, Thomas EM, Cotton LT, Watkins PJ. Improved survival of the diabetic foot: the role of a specialized foot clinic. Q J Med. 1986;60(232):763-71. PMID: 3774959.
7. Albright RH, Manohar NB, Murillo JF, Kengne LAM, Delgado‑Hurtado JJ, Diamond ML, Acciani AL, Fleischer AE. Effectiveness of multidisciplinary care teams in reducing major amputation rate in adults with diabetes: A systematic review & meta‑analysis. Diabetes Res Clin Pract. 2020 Mar;161:107996. doi: 10.1016/j.diabres.2019.107996. Epub 2020 Jan 11. PMID: 31935416.
8. Piťhová P, Fejfarová V, Koliba M, Jirkovská A, Jirkovská J, Kůsová H, Sixta B. Zhodnocení externího auditu podiatrických ambulancí v ČR 2021. Přednáška na 58. Diabetologických dnech, Luhačovice, 4/2022. Abstrakt publikován v DMEV 2022, 25, Suppl.1:27-28.
9. Jirkovská A, Dubský M, Fejfarová V, Jirkovská J, Koliba M, Krawczyk P, Kučera D, Soxta B, Wosková V, Fialová Z, Vrbová T, Klugar M. Syndrom diabetické nohy – prevence, diagnostika a terapie. Adaptovaný doporučený postup na základě mezinárodních guidelines“ Geum, 2022
10. Alonso‑Fernández M, Mediavilla‑Bravo JJ, López‑Simarro F, Comas‑Samper JM, Carramiñana‑Barrera F, Mancera‑Romero J, de Santiago Nocito A; Grupo de Trabajo de Diabetes de SEMERGEN. Evaluation of diabetic foot screening in Primary Care. Endocrinol Nutr. 2014;61(6):311-7. English, Spanish. doi: 10.1016/j.endonu.2014. 01. 007. Epub 2014 Feb 25. PMID: 24582291.
11. Sánchez‑Ríos JP, García‑Klepzig JL, Manu C, Ahluwalia R, Lüdemann C, Meloni M, Lacopi E, De Buruaga VR, Bouillet B, Vouillarmet J, Lázaro‑Martínez JL, Van Acker K. Referral of patients with diabetic foot ulcers in four European countries: patient follow‑up after first GP visit. J Wound Care. 2019 Aug 1;28(Sup8):S4-S14. doi: 10.12968/jowc.2019. 28. Sup8. S4. PMID: 31393783.
12. Lin CW, Yang HM, Hung SY, Chen IW, Huang YY. The analysis for time of referral to a medical center among patients with diabetic foot infection. BMC Fam Pract. 2021;22(1):16. doi: 10.1186/s12875-020-01363-y. PMID: 33422005; PMCID: PMC7797140.
13. Macfarlane RM, Jeffcoate WJ. Factors contributing to the presentation of diabetic foot ulcers. Diabet Med. 1997;14:867–70.
14. Sanders AP, Stoeldraaijers LG, Pero MW, Hermkes PJ, Carolina RC, Elders PJ. Patient and professional delay in the referral trajectory of patients with diabetic foot ulcers. Diabetes Res Clin Pract. 2013;102(2):105-11. doi: 10.1016/j.diabres.2013. 09. 016. Epub 2013 Oct 1. PMID: 24145054.
15. Guest JF, Fuller GW, Vowden P. Diabetic foot ulcer management in clinical practice in the UK: costs and outcomes. Int Wound J. 2018;15(1):43-52. doi: 10.1111/iwj.12816. Epub 2017 Dec 15. PMID: 29243399
16. Fejfarová V, Koliba M, Jirkovská J, Kůsová H, Piťhová P, Jirkovská A, Sixta B. Je podiatrické péče v ČR dostupná? Aktuální medicína. 2022;1:39-42.
17. Vainieri E, Ahluwalia R, Slim H, Walton D, Manu C, Taori S, Wilkins J, Huang DY, Edmonds M, Rashid H, Kavarthapu V, Vas PRJ. Outcomes after Emergency Admission with a Diabetic Foot Attack Indicate a High Rate of Healing and Limb Salvage But Increased Mortality: 18-Month Follow‑up Study. Exp Clin Endocrinol Diabetes. 2022 Mar;130(3):165-171. doi: 10.1055/a-1322-4811. Epub 2020 Dec 22. PMID: 33352595.
18. Fejfarová V, Jirkovská A, Dragomirecká E, Game F, Bém R, Dubský M, Wosková V, Křížová M, Skibová J, Wu S. Does the diabetic foot have a significant impact on selected psychological or social characteristics of patients with diabetes mellitus? J Diabetes Res. 2014;2014:371938. doi: 10.1155/2014/371938. Epub 2014 Mar 25. PMID: 24791012; PMCID: PMC3984852.
19. Prompers L, Huijberts M, Schaper N, Apelqvist J, Bakker K, Edmonds M, Holstein P, Jude E, Jirkovska A, Mauricio D, Piaggesi A, Reike H, Spraul M, Van Acker K, Van Baal S, Van Merode F, Uccioli L, Urbancic V, Ragnarson Tennvall G. Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study. Diabetologia. 2008;51(10):1826-34. doi: 10.1007/s00125-008-1089-6. Epub 2008 Jul 22. PMID: 18648766.
Štítky
Diabetology Endocrinology Internal medicineČlánok vyšiel v časopise
Internal Medicine
2022 Číslo E-7
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