Podiatric Care Associated with Reduced Mortality and Enhanced Amputation-Free Survival

Area of Science:

• Podiatric Medicine
• Diabetology
• Public Health

Background:

• Diabetic foot ulcers (DFUs) and lower-extremity amputations (LEAs) are major causes of morbidity and mortality in diabetes mellitus.
• Limited evidence exists on the impact of podiatric care on mortality and healthcare resource utilization, particularly in Asia.
• Inadequate access to specialized podiatric care is a significant issue in many regions, including Asia.

Purpose of the Study:

• To evaluate the clinical and healthcare utilization outcomes of patients with DFUs who received podiatric care.
• To assess the effectiveness of podiatric interventions in improving limb salvage and survival rates.
• To analyze the impact of podiatric care on hospital admissions, emergency department visits, and length of stay.

Main Methods:

• A 2-year longitudinal study (DEFINITE Care) involving 2798 patients with DFUs.
• Outcomes assessed included minor/major LEA, mortality, LEA-free survival, admissions, clinic/ED visits, and length of stay.
• Statistical analyses employed multiple logistic and zero-inflated negative binomial regressions, adjusting for covariates.

Main Results:

• Patients receiving podiatric care showed fewer deaths (p < 0.01) and greater LEA-free survival (OR, 1.26; p = 0.02).
• Increased admissions and emergency department visits were observed (p < 0.01), but with a shorter length of stay (IRR, 0.833; p < 0.01).
• More minor LEAs occurred (p < 0.01), but overall clinical outcomes, particularly limb salvage, were improved.

Conclusions:

• Podiatric care significantly enhances clinical outcomes for DFU patients, notably improving LEA-free survival.
• The study demonstrates a positive impact of podiatric care on healthcare utilization patterns.
• Findings provide crucial evidence supporting podiatric care for diabetic limb salvage in Asian populations.