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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)

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.
Original languageEnglish
Article number107837
Number of pages21
JournalJournal of Diabetes and its Complications
Volume35
Issue number4
DOIs
Publication statusPublished - 1 Apr 2021

Keywords

  • Diabetic foot
  • Foot ulcer
  • Lower extremity amputation
  • Meta-analysis
  • Risk
  • Systematic review

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