Сахарный диабет (Dec 2011)
Experience with the treatment of diabetic foot syndrome in Barnaul
Abstract
The interdisciplinary service organized in the city of Barnaul provides care for patients with diabetic foot syndrome (DFS) including regular medicalexamination, diagnostics, treatment, and prophylactic measures to prevent new lesions and amputations. The service is based on the DiabeticFoot Cabinet of City Hospital No 5, Department of Wound Infections of City Hospital No 3, and Barnaul Prosthetics and Orthopedics Company,a manufacturer of prostheses and orthopedic devices for patients with DFS. These organizations have just begun cooperation with the Departmentsof Vascular Surgery of City Hospital No 5 and Regional Clinical Hospital aimed to perform vascular reconstructive surgery. The joint efforts areexpected to ensure long-term observation of the patients, their education in podiatric self-care, and introduction of the total contact cast method foroff-loading the foot at the stage of ulcer formation with the ultimate purpose of reducing it by 45-75%. Almost 3000 patients (10,000 visits) have beenexamined by specialist of Diabetic Foot Cabinet since 2005; most of them were referred to the group of high and very high risk of foot ulceration. Thenumber of patients with DFS hospitalized for the treatment of wound infections decreased from 263 in 2005 to 122 in 2010 despite a rise in overalldiabetes morbidity among the population of Barnaul. During the same period, the total number of amputations decreased from 269 to 64 and thenumber of high-level amputations from 119 to 3. The number of amputations in the patients regularly visiting the Cabinet is much lower than in thegeneral population and continues to decrease (4.7% in 2008 and 1.6% in 2010). 23% of the patients with DFS referred to the Cabinet underwentamputation in 2008 compared with 11% in 2010. In 2010, savings to the Altai region budget in direct medical expenditures for the patients with DFSamounted to 41,000,000 rubles (exclusive of management and drug costs and social benefits). The total savings to the budget in direct expendituresfor the hospital-based treatment of such patients during the last 3 years are estimated at more than 108,000,000 rubles.
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