Reducing Lower Extremity Amputations Due to Diabetes: The Application of Diabetic-Foot Protocol in Chiang Mai University Hospital

Abstract

The aim of this study was to determine whether intensive treatment and education strategies for diabetic patients with ulcers help in preventing leg amputation. From August 2005 to March 2007, a diabetic-foot protocol using a multidisciplinary approach was applied at our hospital. All the subjects were educated regarding diabetic-foot disease and its complications and prevention. This report compares the amputation rate in patients receiving the protocol care from August 2005 to March 2007 with those who had standard care from August 2003 to July 2005. Seventy-three and 110 diabetic-foot ulcer patients received protocol and standard foot care, respectively. The incidence of major amputations in the protocol and standard care groups was 4.1% and 13.6%, respectively (P= .03). Our protocol was associated with improved diabetic-foot care outcomes. It can be used by any hospital to improve outcomes for patients with diabetes.

History of foot ulcers increases mortality among patients with diabetes in Northern Thailand

“…However, 59.4% of neuropathic foot ulcers had infection, which might indirectly reflect the fact that those patients did not actually practice what they knew to be good foot care. After attending our self foot care programme, the percentage of patients who understood the regimen increased to 95.8% [6], but the percentage of actual practice of this foot care could not be determined. Because of differing religious practices, self foot care is difficult to follow.…”

Utilization of foot care services among homeless adults: Implications for advanced practice nurses

“…The evidence indicates that foot examinations of patients with diabetes performed by a podiatrist, along with providing foot education to the individual, can be highly effective in prevention and early detection of foot pathology, as well as in the improvement of self‐efficacy skills of patients (Borges & Ostwald, 2008; Magwood, Zapka, & Jenkins, 2008; O’Brien et al, 2003). Researchers suggest that tracking systems, patient education, foot protocols, evaluation programs, and designated foot care teams can contribute to the preservation of lower extremities and improve outcomes among diabetic patients (Rerkasem et al, 2008).…”

Risk Factors of Methicillin-Resistant Staphylococcus Aureus and Pseudomonas Infection in Diabetic Foot Ulcers in Korea

“…d. Consider providing empiric therapy directed against methicillin-resistant Staphylococcus aureus (MRSA) in a patient with a prior history of MRSA infection; when the local prevalence of MRSA colonization or infection is high; or if the infection is clinically severe (weak, low). 22. We recommend that definitive therapy be based on the results of an appropriately obtained culture and sensitivity testing of a wound specimen as well as the patient's clinical response to the empiric regimen (strong, low).…”

“…Recent studies have shown that adopting even relatively simple protocols with no increase in staffing can lead to improved outcomes and lower costs [21]. Hospitals in small or underdeveloped areas have also shown statistically significant improvements in outcomes of DFI after adopting systems of education and applying multidisciplinary protocols [22]. We agree with the conclusions of the authors of a study that used a risk-based Markov analysis of data from Dutch studies that "management of the diabetic foot according to guideline-based care improves survival, reduces diabetic foot complications, and is cost-effective and even cost saving compared with standard care" [23].…”