A systematic review with meta-analysis of the impact of access and quality of diabetic foot care delivery in preventing lower extremity amputation.
Abstract
Aims To assess the impact of diabetic foot care delivery in preventing lower extremity amputation (LEA).Methods We systematically searched the MEDLINE database for research evaluating the association between any aspect of diabetic foot care delivery and risk of LEA. Meta-analysis was conducted by calculating a pooled odds ratio through a random effects model.Results Our search retrieved 5093 articles. In total, 58 articles were included: 9 addressing healthcare access, 4 educating health professionals, 2 implementing guidelines, 6 receiving chiropody/podiatry care services and 37 implementing structured diabetic foot care services (SDFC). All of these aspects of diabetic foot care seemed to have a positive impact on preventing LEA. Only SDFC literature met criteria for performing a meta-analysis. For SDFC impact on preventing overall and major LEA but not for minor LEA compelling evidence was observed [aggregated odds ratio (OR) of 0.45 (95% CI 0.37-0.57), 0.40 (95% CI 0.32-0.51), and 0.87 (95% CI 0.67-1.14), respectively]. However, high heterogeneity (superior to 60%) was observed for all outcomes.Conclusions Results support a reduction in diabetic LEA frequency in association with structured diabetic foot care, and, in particular, major LEA. Less evidence is available for the remaining aspects of diabetic foot care delivery.
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In that trial, there was no difference in incidence of minor amputations between antibiotic and surgery groups (16.6% vs 13.6%; P = .34).
“There was no difference in the incidence of minor amputations between groups (16.6% vs 13.6%; P = .34).79”
From Diabetic Foot Ulcers (2023) · cites this paper as [79]
In a single-center trial of 46 patients with forefoot osteomyelitis and diabetic foot ulcers, median time to healing was 7 weeks in the antibiotic group vs 6 weeks in the surgery group (P = .72).
“The median time to healing was 7 weeks in the antibiotic group vs 6 weeks in the surgery group (P = .72).”
From Diabetic Foot Ulcers (2023) · cites this paper as [79]
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- Authors
- Monteiro-Soares, M., Vale-Lima, J., Martiniano, J., Pinheiro-Torres, S., Dias, V., & Boyko, E. J.
- Affiliations
- Universidade Católica Portuguesa (PT)
- University of Washington (US)
- Venue
- Journal of Diabetes and its Complications
- Publisher
- Elsevier BV
- Published
- 2021-04
- Volume
- 35
- Issue
- 4
- Pages
- 107837
- ISSN
- 0891-6632 (ISSN-L)
- 1056-8727
- OpenAlex
- W3113711756
- Cited by
- 55
- References
- 73
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 16 · 2023: 10 · 2022: 11 · 2021: 3
- FWCI
- 0.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Diabetes and its Complications (publishedVersion)
- PubMed (publishedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Foot and Ankle Surgery
- Keywords
- diabetic foot care, lower limb amputation, major amputation prevention, health care access, podiatry, chiropody, health professions education, guideline implementation, diabetes complications
- MeSH terms
- Amputation, Surgical, Health Services Accessibility, Humans, Diabetic Foot, Lower Extremity
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