Benefits of a multidisciplinary approach in the management of recurrent diabetic foot ulceration in Lithuania: a prospective study

• Published in: Diabetes care Vol. 22; no. 9; pp. 1428 - 1431
• Main Authors: DARGIS, V, PANTELEJEVA, O, JONUSHAITE, A, VILEIKYTE, L, BOULTON, A. J. M
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-09-1999
• Subjects: Associated diseases and complications; Biological and medical sciences; Care and treatment; Complications and side effects; Diabetes. Impaired glucose tolerance; Diabetic foot; Diabetic Foot - epidemiology; Diabetic Foot - therapy; Diabetic ulcers; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Footwear; Humans; Incidence; Lithuania - epidemiology; Male; Mass Screening - methods; Medical sciences; Middle Aged; Nurses; Patient Education as Topic; Physicians; Podiatry; Prevention; Prospective Studies; Recurrence; Treatment Outcome; United Kingdom; Europe; Lithuania; Endocrinopathy; Performance evaluation; Human; Skin disease; Nervous system diseases; Diabetes mellitus; Health care staff; Lower limb; Physician; Peripheral neuropathy; Foot; Complication; Ulcer; Peripheral nerve disease; Multidisciplinary; Nurse
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.22.9.1428

Benefits of a multidisciplinary approach in the management of recurrent diabetic foot ulceration in Lithuania: a prospective
study.
V Dargis ,
O Pantelejeva ,
A Jonushaite ,
L Vileikyte and
A J Boulton
Rehabilitation Hospital, Kaunas, Lithuania. [e-mail]
Abstract
OBJECTIVE: To assess the ability of a multidisciplinary approach to diabetic foot care to reduce the incidence of recurrent
ulceration and amputations compared with standard care in a 2-year prospective study. RESEARCH DESIGN AND METHODS: A total
of 145 patients with a past history of neuropathic foot ulcers but no evidence of peripheral vascular disease entered the
study. Subjects were screened for their neuropathic and vascular status at baseline, and all received identical foot care
education. The intervention group (n = 56) was followed by the multidisciplinary team of physicians, nurses, and podiatrists
with regular podiatry and reeducation every 3 months and the provision of specialty footwear as required. The standard treatment
group was followed in local clinics on a trimonthly basis and received identical screening and education at baseline. RESULTS:
There were no significant differences at baseline in age (intervention 59.2+/-13.4, standard treatment 58.5+/-11.5 years),
duration of diabetes (14.0+/-7.1 vs. 15.6+/-7.8 years), or neuropathic status (vibration perception threshold [VPT]: 31.1+/-12.1
vs. 33.9+/-11.3 V, neuropathy disability score [NDS]: 8.1+/-1.4 vs. 7.9+/-1.7). All patients had an ankle brachial pressure
index (ABPI) of >0.9 and at least one palpable foot pulse. Significantly fewer recurrent ulcers were seen in the intervention
group than in the standard treatment group during the 2-year period (30.4 vs. 58.4%, P < 0.001). CONCLUSIONS: This prospective
study has demonstrated the effectiveness of a multidisciplinary approach to diabetic foot care together with the provision
of specialty footwear in the long-term management of high-risk patients with a history of neuropathic foot ulcers.