Diabetes Metab J.  2018 Aug;42(4):308-319. 10.4093/dmj.2017.0076.

The Changes of Trends in the Diagnosis and Treatment of Diabetic Foot Ulcer over a 10-Year Period: Single Center Study

• Kim CH
• Moon JS
• Chung SM
• Kong EJ
• Park CH
• Yoon WS
• Kim TG
• Kim W
• Yoon JS
• Won KC
• Lee HW

• KMID: 2418719
• DOI: http://doi.org/10.4093/dmj.2017.0076

Abstract

BACKGROUND
This study aims to describe the trends in the severity and treatment modality of patients with diabetic foot ulcer (DFU) at a single tertiary referral center in Korea over the last 10 years and compare the outcomes before and after the introduction of a multidisciplinary diabetic foot team.
METHODS
In this retrospective observational study, electronic medical records of patients from years 2002 to 2015 at single tertiary referral center were reviewed. Based on the year of first admission, patients were assigned to a group either before or after the year 2012, the year the diabetes team launched.
RESULTS
Of the 338 patients with DFU, 229 were first admitted until the year 2011 (group A), while 109 were first admitted since the year 2012 (group B). Mean age was higher in group B, and ulcer size was larger than those of group A. Whereas duration of diabetes was longer in group B, glycemic control was improved (mean glycosylated hemoglobin, 9.48% vs. 8.50%). The proportion of minor lower extremity amputation (LEA) was increased, but length of hospital stay was decreased (73.7±79.6 days vs. 39.8±36.9 days). As critical ischemic limb increased, the proportion of major LEA was not decreased.
CONCLUSION
Improved glycemic control, multidisciplinary strategies with prompt surgical treatment resulted in reduced length of hospital stay, but these measures did not reduce major LEAs. The increase in critical ischemic limb may have played a role in the unexpected outcome, and may suggest the need for increased vascular intervention strategies in DFU treatment.

Keyword

Amputation; Diabetic foot; Length of stay; Patient care team

MeSH Terms

Amputation
Diabetic Foot*
Diagnosis*
Electronic Health Records
Extremities
Hemoglobin A, Glycosylated
Humans
Korea
Length of Stay
Lower Extremity
Observational Study
Patient Care Team
Retrospective Studies
Tertiary Care Centers
Ulcer*

Figure

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  Fig. 1 Reported causes of diabetic foot ulcer in (A) group A and (B) group B.

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  Fig. 2 Comparison of the proportion of lower extremity amputations between group A and group B. No, no amputation; Minor, below-ankle amputation; Major, above-ankle amputation.

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  Fig. 3 Comparison of major amputation causes according to (A) Wagner classification system and (B) University of Texas classification between groups.

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  Fig. 4 Comparison of (A) length of admission and (B) peripheral percutaneous transluminal angiography (PTA) procedures between group A and group B.

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