Effectiveness of multidisciplinary care teams in reducing major amputation rate in adults with diabetes: A systematic review & meta-analysis

Abstract

A B S T R A C TAims: To determine the pooled effectiveness of multidiscipinary care teams (MCTs) in reducing major amputation rates in adults with diabetes.Methods: A systematic review and meta-analysis was performed, searching databases MEDLINE, EMBASE, Google Scholar, Cochrane Library, and Clinicaltrials.gov thru October 2018. We included only before-after studies comparing amputation rates before and after the implementation of a MCT for the prevention of major amputation in adults with diabetes. Our primary outcome was relative risk of major amputation. Risk ratios and 95% confidence intervals were calculated using a fixed effects model. Results: Twenty studies met the inclusion criteria. Nine studies were included in the metaanalysis, and eleven were included in a qualitative analysis. Exposure to a MCT resulted in a protective effect ranging from a RR of 0.44 [p-value < 0.00001 (95% CI 0.38, 0.51) I 2 = 67%] to a RR of 0.61 [p-value < 0.0001, (95% CI 0.50, 0.75) I 2 = 0%] after sensitivity analysis, and remained robust in qualitative analysis. Conclusions:Healthcare systems can expect a 39-56% amputation rate reduction after implementing an MCT amputation prevention program. These findings may justify the use of additional resources needed for program implementation by helping healthcare systems predict the anticipated benefit these teams have on ''possible limbs saved".Funding: None.

Rapid access to multidisciplinary diabetes foot care teams

“…Management guidelines for foot ulcers in people with diabetes vary internationally, but the UK’s National Institute for Health and Care Excellence (NICE) recognises the need for rapid assessment and treatment by a multidisciplinary diabetes foot care team 1. Implementation of foot care teams has been shown to reduce rates of major amputation in adults with diabetes by 39-56%,2 and recent data suggest that early referral is associated with better outcomes 3…”

Counting the cost of preventable diabetes-related lower limb amputations at a single district hospital in KwaZulu-Natal: what does this mean, what can be done?

“…1 As far back as 2005, it was highlighted that a major barrier to addressing the skills shortage of such practitioners is the lack of additional training institutions for podiatric medicine on the African continent. 34 This paper makes a further call for expanded training of the discipline of podiatric medicine at medical schools, particularly within KwaZulu-Natal where it is absent.…”

The effects of curcumin intake on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double‐blind, placebo‐controlled trial

“…Furthermore, the size of ulcer is considered as a risk factor for amputation in patients who present DFU (Lee et al, 2020). Accordingly, effective management of foot ulcer may lead to the prevention of amputation (Albright et al, 2020; Thomas, 2015). Several mechanisms have been proposed for curcumin wound healing activities, including modulation of inflammatory status through the inhibitory effects on nuclear factor kappa B (NF‐κB) pathway, increasing in the activity of antioxidant enzymes, enhancement of remodeling by increasing the biosynthesis of extracellular matrix (ECM) and transforming growth factor (TGF)‐B, and the increasing of fibroblast proliferation (Barchitta et al, 2019; Mohanty & Sahoo, 2017).…”