The Development and Application of Diabetic Foot Protocol in Chiang Mai University Hospital With an Aim to Reduce Lower Extremity Amputation in Thai Population: A Preliminary Communication

Lower extremity amputation is a frequent complication of diabetes, and the authors' region did not have effective strategies to minimize it. From August 2005 to July 2006, a diabetic foot protocol (DFP) for out-patient management based on a multidisciplinary team approach was tried at the local teaching hospital. There are devices to reduce pressure and educate. After healing, there are custom fabricated orthoses and footwear, and monitoring of progressive ambulation. This report compares the amputation rate in patients receiving DFP care from August 2005 to July 2006 with those who had standard care from August 2003 to July 2005. Sixty-one and 110 diabetic foot ulcer patients received DFP and standard foot care, respectively. Their sex distribution and mean age were similar. The incidence of major amputations in the DFP and standard care groups was 3.3% and 13.6%, respectively (P = .03). The incidence of minor amputations in the DFP and standard care groups was 3.4% and 15.8%, respectively (P = .02). DFP was associated with improved diabetic foot care outcomes. It may be used by clinical teams with a view to improve outcomes for patients with diabetes.

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

AIMS

Studies within the Caucasian population with diabetes showed an increased mortality in patients with diabetic foot ulcers. However, there were no such studies based on Asian populations. We therefore designed our study on the association of foot ulcer with mortality within the Asian population.

METHODS

Ninety-seven Asian individuals with diabetes who had previously participated in the 'Multidisciplinary Diabetic Foot Protocol' between 2005 and 2007 at our centre were followed up in 2010 to ascertain their mortality rate. Cox proportional-hazard regression analyses were used to estimate hazard ratios.

RESULTS

Forty-seven patients had a history of foot ulcer (group 1), while 50 had none (group 2). The mean follow-up was 43.74 months. Twenty-one patients died during this period (21.65%). The mortality rates in group 1 and group 2 were 15 (31.92%) and six (12.00%), respectively. Patients with a history of foot ulcer had higher mortality rates than those without (hazard ratio 3.51, 95% CI 1.03-11.96, P = 0.04).

CONCLUSIONS

Our study showed that history of foot ulcer increased mortality. This association appeared to be stronger in younger Asian patients than those in the Caucasian populations.

A Multidisciplinary Diabetic Foot Protocol at Chiang Mai University Hospital: Cost and Quality of Life

The consensus is that a multidisciplinary approach for patients with diabetic foot ulcer is effective in reducing the number of leg amputations. Concern remains, however, about cost and health-related quality of life issues. From August 2005 to March 2007, a multidisciplinary diabetic foot protocol (DFP) was used at the authors’ teaching hospital.There were devices to reduce pressure on the foot.After healing, there were custom-fabricated orthoses and footwear, and monitoring of progress in ambulation. All subjects were educated about diabetic foot disease and its complications and prevention.They were also instructed to call and visit the hospital if there were any signs of new lesions.This study compared responses to the short form 36 questionnaires (SF-36) about health-related quality of life and the cost of medical care for patients receiving DFP care from August 2005 to March 2007 and those who had standard care from August 2003 to July 2005.There were 56 and 40 diabetic foot ulcer patients on DFP and standard care packages, respectively. Their gender distribution and mean age were similar. The average total cost of DFP patients was significantly lower than that for standard care patients ($1127.02 and $1824.58, respectively, P = .02). DFP patients had significantly higher scores on the SF-36 for both the physical and mental health dimensions than standard care patients. It was concluded that DFP was less expensive and gave patients a better quality of life, compared to standard care. On the basis of this finding, DFP should be used by every hospital to improve outcomes for patients with diabetic foot ulcer.