Multidisciplinary Approach to Prevent Limb Amputation in Diabetic Patients

Abstract

Diabetes mellitus is a complex disease with clinical sequelae including cardiovascular disease, renal failure, extremity complications, and death. Lower limb amputation is the most serious morbidity and consequence for diabetic patients due to its associated burden on quality of life and economic implications. Limb amputation is caused by a series of complications involving multiple organ systems. We believe that a multidisciplinary diabetic care team, consisting of vascular specialists, wound care specialists, and cardiologists, will facilitate in systematically addressing each complication leading to amputation. Diabetic patients have an increased risk of developing cardiovascular diseases, resulting in the expanding involvement and importance of interventional cardiologists on these multidisciplinary diabetic care teams. Several national and global institutions have successfully demonstrated the multidisciplinary approach to facilitate efficient and timely care, and most importantly, reduce the rates of diabetes-related limb amputation. The Heart, Vascular and Leg Center coordinates vascular specialty care and provides dedicated patient management in order to increase treatment quality, patient literacy, and medication adherence to decrease lower extremity amputation rates.

Metatranscriptomic Analysis Reveals Active Bacterial Communities in Diabetic Foot Infections

“…Diabetic foot infections are the most severe and costly complication of diabetes. With regards to the diabetic population, 50% of them are recognized to have ulcerated feet (Gupta and Kumar, 2019). Progression of DFIs to more complicated scenarios, such as minor and major amputation of a lower limb occurs every 30 s in the world which can influence the quality of life in many diabetic people worldwide 1 .…”

Evaluating the Impact of the Diabetes Mellitus Strategy for the National Health System: An Interrupted Time Series Analysis

“…The approval of the SDM-NHS may have generated a dynamic that resulted in the better control of glycaemia levels and the rest of the biochemical blood parameters typically used to monitor and estimate the quality of care for patients with DM as well as associated cardiovascular risk management. The final effect of those changes would have been the improvement of cardiovascular indicators related to DM [ 30 , 31 ]. However, the degree of granularity of the data available does not enable us to ascertain whether improvements in the control of variables such as HbA1c, blood glucose, BP, cholesterol or body mass index have been registered over the period analyzed, nor whether there have been changes in the patterns of treatment of DM.…”

Facilitating manual wheelchair skills following lower limb amputation using a group process: A nested mixed methods pilot study

“…The rehabilitation process varies depending on the cause of amputation (traumatic or vascular), the mental and physical capabilities of the individual and the potential of the amputated leg to be fitted with a prosthesis (Fiedler et al, 2014 ). Regardless of whether they will be a prosthetic user, most Australian people experiencing lower limb amputations are prescribed a manual wheelchair, in the anticipation that it will support independence with mobility (Fiedler et al, 2014 ; Gupta & Kumar, 2019 ). Simply providing a wheelchair does not equate to its safe and functional use.…”