Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Observational study of admissions to the inpatient Multidisciplinary Diabetic Foot Unit at Fiona Stanley Hospital: glycaemic control and renal function at 12 months (#287)

Jita Anil 1 , Wendy A Davis 2 , Lydia Lamb 3 , Dipen Sankhesara 1 , Tina Dilevska 4 , Erica Ryan 5 , Ashley Makepeace 3 , P. Gerry Fegan 3 , Carsten Ritter 4 , Laurens Manning 6 , Emma J Hamilton 3 7
  1. General Medicine, Fiona Stanley Hospital, Perth, WA, Australia
  2. Medical School, University of Western Australia, Fremantle Hospital, Perth, WA, Australia
  3. Endocrinology Department, Fiona Stanley Hospital, Perth, WA, Australia
  4. Vascular Surgery Department, Fiona Stanley Hospital, Perth, WA, Australia
  5. Podiatry Department, Fiona Stanley Hospital, Perth, WA, Australia
  6. Infectious Diseases Department, Fiona Stanley Hospital, Perth, WA, Australia
  7. Fiona Stanley Hospital, Murdoch, WA, Australia

Background

A multidisciplinary approach to diabetic foot disease reduces amputation rates and improves wound healing.  In February 2015, the first inpatient Multidisciplinary Diabetic Foot Unit (MDFU) in Western Australia was opened at Fiona Stanley Hospital (FSH).

Aims

To describe changes in glycaemic control and renal function for the 12 month period following index admission in patients admitted to FSH MDFU.

Methods

A retrospective observational study of 151 admissions in 128 patients admitted to FSH MDFU from 1st February 2015 to January 31st 2016. HbA1c, eGFR and CKD stage are reported 12 months following index admission.

Results

The 128 patients had a mean±SD age of 60.4±14.9 years; 85.9% had type 2 diabetes and 11.7% type 1 diabetes.  Median [interquartile range] HbA1c at baseline (index admission) was 8.7 [7.1 -10.5]% (n=123) and mean±SD eGFR was 65±31 ml/min/1.73m2 (n=127).  In those not lost to follow-up or dying within the 12 months following index admission and with available data, change in HbA1c (95%CI) at 0 to 3 months (n=31) was -0.8 (-1.4 to -0.2)%,  P=0.007, at 3 to 6 months (n=33) was -0.5 (-1.2 to 0.3)%, P =0.21 and at 6 to 12 months (n=36) was -0.3 (-0.8 to 0.2)%, P =0.25.  Change in eGFR at 12±3months (n=32) was -3.9 (-9.8 to 2.1), P =0.20.  By CKD stage, renal function deteriorated by one or two stage(s) in 22.5%, remained the same in 52.5%, and improved in 25.0% between admission and follow-up at 12±3months, P=0.82.

Conclusions

Initial improvements in glycaemic control were not sustained over the longer term whilst renal function remained stable or improved in the majority of patients, although conclusions are constrained by relatively small numbers of patients with follow-up data. The role of psychological strategies to improve diabetes self-care in patients with diabetic foot complications warrants exploration in future studies.