The Multidisciplinary Team Is Key in Treating Diabetic Foot
Pablo Hernández Mares, MA March 14, 2023
UADALAJARA, Mexico — Medical, surgical, vascular, and rehabilitation/prevention: these are the four key teams that should be involved in the treatment of patients with diabetic foot, according to Giacomo Clerici, MD, a diabetic foot surgeon at San Carlo Hospital Paderno D., in Milan, Italy. He presented his article, “Multidisciplinary Approach and Diabetic Foot: The Key Strategy to Reduce Amputations,” at the Annual Congress of International Cardiology (CADECI) 2023.
“Diabetic foot is a syndrome that leads to a heightened risk of amputation and mortality. For this reason, it needs to be managed by a multidisciplinary team,” said Clerici.
Just as an orchestra has a conductor, so does this team have a key member who leads, directs, and guides the players. This individual must be able to manage impaired metabolic control, diabetic complications, comorbidities (renal function, nutrition, anemia, cardiovascular risk factors, pain), and acute and chronic ulcers; diagnose soft tissue and bone infections; administer antibiotic therapy; and perform basic and emergent foot surgery. “But in particular,” Clerici added, “they have to be able to foster collaboration among all of the members of the team.
“There’s no such thing as a superspecialist who’s able to handle all aspects related to the treatment of patients with diabetic foot,” he said. “So, it’s important that we come together to create a sense of being that single medical professional. One cohesive unit, like an orchestra — or, if you like, Scuderia Ferrari. In the end, a unified and consolidated team of specialists.
” One study reported that in the period 2001–2010, a progressive reduction of amputee rates of more than 30% was observed for major amputations among persons with diabetes in Italy — a result ascribed, in part, to the implementation of this type of multidisciplinary team model.
Medscape Spanish Edition spoke with Daphne González, MD, co-chair of CADECI 2023’s Peripheral Vascular Diabetic Foot module. “There’s no better way to treat diabetic foot than with a multidisciplinary approach, bringing together a number of different healthcare professionals: endocrinologists, podiatrists, specialists in infectious diseases…. This is because, as we know, diabetic foot wounds are prone to infection. So, these physicians must be brought in to ensure that the patients are getting the appropriate antibiotics — because, as we also know, with diabetic foot infections, we’re dealing with multidrug-resistant bacteria.
” Clerici brought up the analysis of amputation risk and how it affects three patient groups: those with infection, those with ischemia, and those with ischemia and infection. “But I’d like to add another group to the high-risk list: those with Charcot foot. These patients can end up being at very high risk of amputation if we don’t make the right diagnosis and provide the correct treatment, especially in the early stages, when these individuals only have sites of inflammation without any other symptoms or any other clinical findings.” For these patients, there are three grades of infection, mild, moderate, and severe. Those with a severe or deep infection should be hospitalized and treated.
Clerici highlighted the fact that diabetes causes long-term complications that can affect all aspects of the foot, from the anatomic — toes and nerves — to the functional — walking and supporting one’s weight when standing.
“But the main concern for patients with diabetic foot is survival. As we know, this syndrome is associated with a really high risk of death,” Clerici noted. He explained that mortality at 5 years for an individual with a diabetic foot ulcer is 2.5 times as high as the risk for an individual with diabetes who does not have a foot ulcer.
He went on to point out that the 5-year relative mortality rate is higher for patients with diabetic foot than for those with the most common cancers.
González agreed, adding that, in Mexico, diabetic foot is a problem of pandemic proportions. “It’s a complication of diabetes that’s more common than we’d like to see. And we have to identify it in time, because we know that once it’s advanced, the chance of limb loss is very high, and, I’m sorry to say, there have been many limbs lost to diabetic foot.
“However, there is hope that new treatments will improve this landscape,” González said. “We already have a lot of devices that can reach even the tiniest arteries in the foot. Patients with diabetes don’t have good circulation in the most distal arteries, and these devices are made to restore circulation. And because we have more technology,” she noted, “quite a few diabetic feet have been saved. These days, as long as the issue is identified in time, there are many things that can be done to try to save the limb, a limb that, in the past, would have been a case of certain amputation.”