TY - JOUR
T1 - Multidisciplinary team led by internists improves diabetic foot ulceration outcomes a before-after retrospective study
AU - Ayada, Gida
AU - Edel, Yonatan
AU - Burg, Alon
AU - Bachar, Adi
AU - Hayun, Yehiel
AU - Shochat, Tzippy
AU - Bishara, Jihad
AU - Yahav, Dafna
AU - Atamna, Alaa
AU - Elis, Avishay
N1 - Publisher Copyright:
© 2021
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Study objective: Diabetic foot ulceration (DFU) is associated with high mortality and morbidity. A multidisciplinary approach has been suggested, but as these patients usually present with various comorbidities, leadership of a multidisciplinary team by internists was initiated. Our aim was to evaluate the impact of the leadership of the multidisciplinary team by internists on the outcomes of patients with DFU. Methods: Outcomes of patients with salvable DFU admitted pre and post introduction of the multidisciplinary team were compared, i.e., a major amputation (above or below the knee), blood stream infection, major medical complications, 30 day mortality, vascular interventions, diabetes control, medication regiments and laboratory results. Results: The cohort included 315 patients, 207 - multidisciplinary pre-period and 108 - multidisciplinary period. During the multidisciplinary period, the rates of major amputations, blood stream infections were found significantly lower than the pre-multidisciplinary period (10% vs. 14%; p = 0.01 and 2% vs. 13%, p = 0.04, respectively). The 30 day mortality rates tended to be lower (5% vs. 11%, p = 0.08). Vascular interventions increased significantly (18% vs. 1%, p<0.01). The diabetes control significantly improved (median glucose levels 163 vs. 185 mg/dl, p = 0.03). Treatment consisting of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, statins) were updated and laboratory results at discharge (albumin, CRP) showed improved disease control. Conclusion: The treatment of hospitalized DFU patients by a multidisciplinary team led by internists using a holistic therapeutic approach demonstrated improved clinical outcomes.
AB - Study objective: Diabetic foot ulceration (DFU) is associated with high mortality and morbidity. A multidisciplinary approach has been suggested, but as these patients usually present with various comorbidities, leadership of a multidisciplinary team by internists was initiated. Our aim was to evaluate the impact of the leadership of the multidisciplinary team by internists on the outcomes of patients with DFU. Methods: Outcomes of patients with salvable DFU admitted pre and post introduction of the multidisciplinary team were compared, i.e., a major amputation (above or below the knee), blood stream infection, major medical complications, 30 day mortality, vascular interventions, diabetes control, medication regiments and laboratory results. Results: The cohort included 315 patients, 207 - multidisciplinary pre-period and 108 - multidisciplinary period. During the multidisciplinary period, the rates of major amputations, blood stream infections were found significantly lower than the pre-multidisciplinary period (10% vs. 14%; p = 0.01 and 2% vs. 13%, p = 0.04, respectively). The 30 day mortality rates tended to be lower (5% vs. 11%, p = 0.08). Vascular interventions increased significantly (18% vs. 1%, p<0.01). The diabetes control significantly improved (median glucose levels 163 vs. 185 mg/dl, p = 0.03). Treatment consisting of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, statins) were updated and laboratory results at discharge (albumin, CRP) showed improved disease control. Conclusion: The treatment of hospitalized DFU patients by a multidisciplinary team led by internists using a holistic therapeutic approach demonstrated improved clinical outcomes.
KW - Diabetic foot
KW - Internist(s)
KW - Multidisciplinary team
UR - http://www.scopus.com/inward/record.url?scp=85111504761&partnerID=8YFLogxK
U2 - 10.1016/j.ejim.2021.07.007
DO - 10.1016/j.ejim.2021.07.007
M3 - Article
C2 - 34325949
AN - SCOPUS:85111504761
SN - 0953-6205
VL - 94
SP - 64
EP - 68
JO - European Journal of Internal Medicine
JF - European Journal of Internal Medicine
ER -