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Reducing lower leg amputations in diabetes: a challenge for patients, healthcare providers and the healthcare system.

Schaper NC, Apelqvist J, Bakker K - Diabetologia (2012)

Bottom Line: Amputation of the lower limb is one of the most feared diabetic complications.It is associated with loss of mobility and a poor quality of life.The financial cost is also high for patients and their families, particularly in countries that lack a comprehensive health service and/or have a low income.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology, Department of Internal Medicine, CAPHRI and CARIM Research Institutes, Maastricht University Medical Center+, PO Box 5800, 6202 Maastricht, the Netherlands. n.schaper@mumc.nl

ABSTRACT
Amputation of the lower limb is one of the most feared diabetic complications. It is associated with loss of mobility and a poor quality of life. Amputations result in high economic burden for the healthcare system. The financial cost is also high for patients and their families, particularly in countries that lack a comprehensive health service and/or have a low income. Losing a leg frequently implies financial ruin for a whole family in these countries; therefore, a reduction in diabetes-related amputations is a major global priority. Marked geographical variation in amputation rates has been reported within specific regions of an individual country and between countries. A coordinated healthcare system with a multidisciplinary approach is essential if the number of amputations is to be reduced. This commentary discusses how studies on the variation in amputation rates can help to identify barriers in the access or delivery of care with the aim of reducing the burden of diabetic foot disease.

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The outcome of diabetic foot ulcers is determined by patient and ulcer characteristics, by the local healthcare organisation and availability of resources, by the management strategies used and the attitudes of the care providers and patients. The outcome can be described in clinical terms, such as healing or amputation, in terms of quality of life or in terms of use of resources
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Fig1: The outcome of diabetic foot ulcers is determined by patient and ulcer characteristics, by the local healthcare organisation and availability of resources, by the management strategies used and the attitudes of the care providers and patients. The outcome can be described in clinical terms, such as healing or amputation, in terms of quality of life or in terms of use of resources

Mentions: As reviewed in 2004 in this journal, there are many factors that determine the amputation rate and pinpointing why it varies so markedly in England and elsewhere is a challenge [2] (Fig. 1). Part of the variability reported in the paper by Holman et al [1] could be explained by ethnic differences [6] but, owing to the study design, there is no information on disease severity or management. In the prospective European Study Group on Diabetes and the Lower Extremity (Eurodiale) study, which was performed in 1,232 diabetic patients with a new foot ulcer from all over Europe, the number of major amputations was too low (5%) to analyse, but the minor amputation rate varied markedly between the participating centres, from 2% to 33% [7]. As all patients underwent a comprehensive evaluation, a disease severity score could be calculated for each patient and a large part of the variation could be explained by differences in disease severity (r = 0.75). Amputation rate should therefore not be used as a quality indicator in diabetic foot disease, unless it can be corrected for the relevant characteristics of the patient, the leg and the foot.Fig. 1


Reducing lower leg amputations in diabetes: a challenge for patients, healthcare providers and the healthcare system.

Schaper NC, Apelqvist J, Bakker K - Diabetologia (2012)

The outcome of diabetic foot ulcers is determined by patient and ulcer characteristics, by the local healthcare organisation and availability of resources, by the management strategies used and the attitudes of the care providers and patients. The outcome can be described in clinical terms, such as healing or amputation, in terms of quality of life or in terms of use of resources
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3369138&req=5

Fig1: The outcome of diabetic foot ulcers is determined by patient and ulcer characteristics, by the local healthcare organisation and availability of resources, by the management strategies used and the attitudes of the care providers and patients. The outcome can be described in clinical terms, such as healing or amputation, in terms of quality of life or in terms of use of resources
Mentions: As reviewed in 2004 in this journal, there are many factors that determine the amputation rate and pinpointing why it varies so markedly in England and elsewhere is a challenge [2] (Fig. 1). Part of the variability reported in the paper by Holman et al [1] could be explained by ethnic differences [6] but, owing to the study design, there is no information on disease severity or management. In the prospective European Study Group on Diabetes and the Lower Extremity (Eurodiale) study, which was performed in 1,232 diabetic patients with a new foot ulcer from all over Europe, the number of major amputations was too low (5%) to analyse, but the minor amputation rate varied markedly between the participating centres, from 2% to 33% [7]. As all patients underwent a comprehensive evaluation, a disease severity score could be calculated for each patient and a large part of the variation could be explained by differences in disease severity (r = 0.75). Amputation rate should therefore not be used as a quality indicator in diabetic foot disease, unless it can be corrected for the relevant characteristics of the patient, the leg and the foot.Fig. 1

Bottom Line: Amputation of the lower limb is one of the most feared diabetic complications.It is associated with loss of mobility and a poor quality of life.The financial cost is also high for patients and their families, particularly in countries that lack a comprehensive health service and/or have a low income.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology, Department of Internal Medicine, CAPHRI and CARIM Research Institutes, Maastricht University Medical Center+, PO Box 5800, 6202 Maastricht, the Netherlands. n.schaper@mumc.nl

ABSTRACT
Amputation of the lower limb is one of the most feared diabetic complications. It is associated with loss of mobility and a poor quality of life. Amputations result in high economic burden for the healthcare system. The financial cost is also high for patients and their families, particularly in countries that lack a comprehensive health service and/or have a low income. Losing a leg frequently implies financial ruin for a whole family in these countries; therefore, a reduction in diabetes-related amputations is a major global priority. Marked geographical variation in amputation rates has been reported within specific regions of an individual country and between countries. A coordinated healthcare system with a multidisciplinary approach is essential if the number of amputations is to be reduced. This commentary discusses how studies on the variation in amputation rates can help to identify barriers in the access or delivery of care with the aim of reducing the burden of diabetic foot disease.

Show MeSH
Related in: MedlinePlus