A systematic review with meta-analysis of the impact of access and quality of diabetic foot care delivery in preventing lower extremity amputation

Matilde Monteiro-Soares; Jorge Vale-Lima; João Martiniano; Sofia Pinheiro-Torres; Vanessa Dias; Edward J Boyko

doi:10.1016/j.jdiacomp.2020.107837

A systematic review with meta-analysis of the impact of access and quality of diabetic foot care delivery in preventing lower extremity amputation

J Diabetes Complications. 2021 Apr;35(4):107837. doi: 10.1016/j.jdiacomp.2020.107837. Epub 2020 Dec 31.

Authors

Matilde Monteiro-Soares¹, Jorge Vale-Lima², João Martiniano³, Sofia Pinheiro-Torres⁴, Vanessa Dias⁵, Edward J Boyko⁶

Affiliations

¹ MEDCIDS - Departamento de Medicina da Comunidade Informação e Decisão em Saúde, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: matsoares@med.up.pt.
² Unidade de Saúde Familiar Nova Salus, Agrupamento de Centros de Saúde Grande Porto VII, Vila Nova de Gaia, Portugal.
³ Escola Superior de Saúde da Cruz Vermelha Portuguesa de Lisboa, Portugal.
⁴ Unidade de Saúde Familiar Aldoar, Agrupamento de Centros de Saúde Porto Ocidental, Porto, Portugal.
⁵ Unidade de Saúde Familiar St André de Canidelo, Agrupamento de Centros de Saúde Grande Porto VII, Vila Nova de Gaia, Portugal; Centro de Investigação Interdisciplinar em Saúde(CIIS)- UCP- ICS Porto, Portugal.
⁶ Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs, Puget Sound Health Care System and the University of Washington, Seattle, WA, USA.

PMID: 33423910
DOI: 10.1016/j.jdiacomp.2020.107837

Abstract

Aims: To assess the impact of diabetic foot care delivery in preventing lower extremity amputation (LEA).

Methods: We systematically searched the MEDLINE database for research evaluating the association between any aspect of diabetic foot care delivery and risk of LEA. Meta-analysis was conducted by calculating a pooled odds ratio through a random effects model.

Results: Our search retrieved 5093 articles. In total, 58 articles were included: 9 addressing healthcare access, 4 educating health professionals, 2 implementing guidelines, 6 receiving chiropody/podiatry care services and 37 implementing structured diabetic foot care services (SDFC). All of these aspects of diabetic foot care seemed to have a positive impact on preventing LEA. Only SDFC literature met criteria for performing a meta-analysis. For SDFC impact on preventing overall and major LEA but not for minor LEA compelling evidence was observed [aggregated odds ratio (OR) of 0.45 (95% CI 0.37-0.57), 0.40 (95% CI 0.32-0.51), and 0.87 (95% CI 0.67-1.14), respectively]. However, high heterogeneity (superior to 60%) was observed for all outcomes.

Conclusions: Results support a reduction in diabetic LEA frequency in association with structured diabetic foot care, and, in particular, major LEA. Less evidence is available for the remaining aspects of diabetic foot care delivery.

Keywords: Diabetic foot; Foot ulcer; Lower Extremity Amputation; Meta-analysis, Risk, Systematic Review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Amputation, Surgical
Diabetic Foot* / epidemiology
Diabetic Foot* / prevention & control
Diabetic Foot* / surgery
Health Services Accessibility
Humans
Lower Extremity / surgery