Can DPMs Have An Impact On The Multidisciplinary Team For Patients With Diabetes?

When treating at-risk patients with diabetes, a multidisciplinary team can be invaluable in averting complications such as lower extremity amputation. A recent study in the Journal of the American Podiatric Medical Association says early identification and referral to a podiatric limb preservation team can improve the survival rate of at-risk patients with diabetes.

In a retrospective cohort study involving 485 patients with diabetes, researchers collected data on ulcer status and surgical outcomes for five years in patients who received specialty podiatric medical care (311 patients) and those who did not (174 patients).

The study found the proportion of “minor” amputations was significantly higher in the group receiving advanced multidisciplinary podiatric care (67.3 percent) versus the group that did not receive advanced multidisciplinary podiatric care (33.7 percent). Additionally, authors noted that during the study, 19.5 percent of non-specialty care patients died in comparison with 7.7 percent of patients in the podiatric limb preservation group.

The study authors conclude that decreased rates of proximal amputations and increased rates of survival may result in patients with diabetes when there is early identification of those at risk for ulcerations and subsequent referral to advanced multidisciplinary podiatric medical specialty care.

Educating Patients On The Importance Of Foot Screenings

The most effective method of preventing ulcerations and amputations is a careful and frequent inspection of the diabetic foot, according to lead study author Vickie Driver, DPM, MS. She says one should assess and document abnormalities, whether they are age-related, structural or pathological.

Dr. Driver cites the American Diabetes Association’s 2004 recommendation that patients with diabetes undergo a comprehensive annual foot examination, including a patient history. Dr. Driver and Peter Blume, DPM, cite the importance of the Semmes Weinstein 5.07 monofilament to test for diabetic neuropathy and palpating for pedal pulses.

If patients do not have pedal complications of diabetes, annual screenings are sufficient, according to Dr. Blume, an Assistant Clinical Professor of Surgery in the Anesthesia and Orthopedics and Rehabilitation Department at the Yale School of Medicine. However, if patients do have disease affecting the foot, Dr. Blume says routine foot care is “extremely important” every two to three months along with offloading, education and strict glucose control.

Dr. Driver supports giving patients specific instruction on foot care as well as insights on selecting proper footwear and breaking in shoes in order to help prevent blisters and ulcers.

“It is imperative that patients understand the importance of daily foot exams, the implication of losing their protective sensation and proper foot care,” notes Dr. Driver, an Associate Professor of Surgery and the Director of Clinical Research, Foot Care at the Boston University School of Medicine.

Emphasizing The Role Of DPMs

In addition, Dr. Driver emphasizes that DPMs should spread the word to primary care physicians about their efficacy in treating high-risk patients with diabetes.

“The data now shows that we are cost effective providers to help treat these patients,” maintains Dr. Driver, a Fellow of the American College of Foot and Ankle Surgeons. “We need to present at medical meetings where PCPs attend. This will help them understand how and when to consult us.”