The acute diabetic foot: different clinical patterns with a dedicated fast-track pathway

Area of Science:

• Diabetology
• Podiatry
• Vascular Surgery

Background:

• Delayed referral of patients with diabetic foot ulcers (DFUs) to specialized diabetic foot services (DFS) persists despite guidelines and awareness initiatives.
• Primary care healthcare professionals (HCPs) often lack adequate training in DFU recognition and management.
• DFUs can rapidly progress to diabetic foot attacks (DFAs), characterized by ischemia, infection, or Charcot neuroarthropathy, risking limb and life.

Purpose of the Study:

• To identify clinical patterns of diabetic foot attacks (DFAs).
• To describe DFA characteristics, management pathways, and treatment indications.
• To develop a practical, fast-track referral model for specialized diabetic foot centers based on clinical presentation severity.

Main Methods:

• Clinical pattern identification of diabetic foot attacks (DFAs).
• Description of clinical characteristics, management, and treatment indications for DFAs.
• Development of a fast-track referral model categorizing conditions into emergency (immediate management) and urgent (24-48h specialist evaluation) based on severity.

Main Results:

• The study outlines distinct clinical patterns of diabetic foot attacks (DFAs).
• A fast-track referral model is proposed, differentiating emergency and urgent cases.
• The model aims to guide timely specialist evaluation to prevent clinical deterioration.

Conclusions:

• A practical, fast-track referral model can mitigate delayed referrals for diabetic foot conditions.
• Timely specialist evaluation, guided by the proposed model, is crucial for managing DFAs and preventing adverse outcomes.
• Standardizing referral timing based on DFA severity can improve patient outcomes and reduce amputations.