Сахарный диабет (Sep 2024)
Analysis of the effectiveness of outpatient treatment of patients with diabetic foot
Abstract
BACKGROUND: Diabetic foot syndrome is a late complication of diabetes mellitus and the main reason for non-traumatic amputations of the lower extremities in diabetic patients. Currently, standards of medical care have been developed and implemented for the treatment and prevention of this complication. At the same time, there is a lack of publications on the effectiveness of specialized care, especially at the pre-hospital stage.AIM: To analyze the results of treatment of patients with diabetic foot on an outpatient basis in a specialized department and identify the factors affecting them.MATERIALS AND METHODS: Medical records of patients with diabetic foot ulcers receiving specialized outpatient treatment in the diabetic foot department were analyzed. All patients underwent an assessment of the peripheral sensitivity and blood flow of low extremities during the initial examination. Treatment was prescribed in accordance with the presence and severity of infection and ischemia of the affected limb. The number of amputations at different levels, the percentage of healed and unhealed wounds during the year were analyzed. Predictors of high amputations and non healing during the year were identified.RESULTS: Out of 503 patients with diabetic foot, neuropathic diabetic foot was diagnosed in 336 (67%) patients, neuro-ischemic in 167 (33%). Healing without amputations in the general cohort of patients was noted in 407 cases (81%). In 32 (7%) cases, amputations were required, of which: 23 (5%) within the foot, 3 above ankle (0.6%), 6 above knee (1.2%). Death occurred in 6 patients (1.2%), 2 of them after hip amputation. 61 patients (12%) continued to be treated at the end of the study. The predictors of high amputations in the general cohort of patients were age, impaired arterial blood flow in the arteries of the lower extremities, the depth of the Wagner ulcer and the level of glycated hemoglobin. Predictors of the non healing during the year were: the presence of impaired arterial blood flow and untimely treatment for specialized medical care.CONCLUSION: The data obtained demonstrated the high effectiveness of specialized care for patients with diabetic foot ulcers at the prehospital stage
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