Efficacy of Diabetic Foot Ulcer Treatment and Possible Ways for Improvement: A Retrospective Cohort Study.

BACKGROUND

Diabetic foot (DF) is a dangerous complication of diabetes mellitus (DM). Modern treatment modalities and good organization of care can improve prognosis.

OBJECTIVES

To analyze results of DF treatment in a tertiary care setting and the degree of implementation of international guidelines in practice.

METHODS

We conducted a retrospective analysis of 90 patients treated for DF ulcers/wounds in our center (May-December 2023). Thirty-five patients received only outpatient care. The median age was 65 (37-90) years, 96% had type 2 DM.

RESULTS

Median wound duration was 29 (1-1461) days. Previous treatment was conducted by a family doctor in 30%, at a local wound clinic in 7%, by other medical specialists in 27%, or by the patient/relatives in 29%. At this stage off-loading devices were prescribed for 37%, and 35% were referred to a vascular surgeon. Limb ischemia occurred in 44 patients (49%), revascularization was conducted for 16 patients. At 6 months, healing rates were 48%. Minor or major amputation rates were 4% and 5%, respectively; 6% died, 29% stayed unhealed, and 8% were lost to follow-up. Multivariable analysis revealed independent predictors of non-healing (ethnic group and impossibility of revascularization) and of amputation (previous major amputation, presence of osteomyelitis, and white blood cell count).

CONCLUSIONS

To prevent diabetes-related amputations, healthcare professionals must prioritize preventive care, provide regular podiatry services for high-risk patients, ensure early specialist treatment for any foot ulcer, implement international guidelines at all levels of DF care, and increase the capacity of secondary wound clinics and access to revascularization.