Background: Diabetic foot wounds result in significant morbidity and mortality. Their multifactorial aetiology suggests that they should be addressed in a multi-disciplinary manner. Commencing in March 2016, patients seen in the high-risk foot clinic at Westmead Hospital are offered the support of a multidisciplinary diabetes team whilst receiving routine podiatry care.
Aim: To assess the long-term impact of a brief intervention led by an Endocrinologist and diabetes educator in the care of patients receiving concurrent podiatric treatment for diabetic foot ulcers.
Method: We conducted a retrospective review of patients with diabetic foot ulcers who were reviewed by the podiatry unit between June 2016 and May 2017. Patients agreeing to receive support from the diabetes team were compared to those who received routine podiatry care alone.
Results: We identified 66 patients with diabetic foot ulcer who were seen in June 2016. The mean age was 63.2 years of whom 45 were male and 21 were female. The mean duration of diabetes was 16 years (n=59). 36 (54.5%) patients were reviewed at the High Risk Foot clinic. On average, patients who were assessed by the diabetes team had poorer glycaemic control (mean HbA1c 9.3% vs 8.1%), were more likely to be hospitalised for treatment of foot ulcers (77.5% versus 19%) and to require amputation (52.8% versus 20%).
Conclusion: Higher hospitalisation and amputation rates in patients who were seen by the Diabetes team are likely due to selection bias in which patients with poorer glycaemic control were more likely to be referred. However, these high risk patients may have potentially missed out on specialist review and intervention if they did not attend the High Risk Foot clinic. Further research examining the utility and long-term efficacy of brief intervention by a diabetes team in the high-risk foot wound clinic is underway.