Autor(es): Monteiro-Soares, Matilde ; Vale-Lima, Jorge ; Martiniano, João ; Pinheiro-Torres, Sofia ; Dias, Vanessa ; Boyko, Edward J.
Data: 2020
Identificador Persistente: http://hdl.handle.net/10400.14/31769
Origem: Veritati - Repositório Institucional da Universidade Católica Portuguesa
Assunto(s): Diabetic foot; Foot ulcer; Lower Extremity Amputation; Meta-analysis; Risk; Systematic review
Aims: To assess the impact of diabetic foot care delivery in preventing lower extremity amputation (LEA). Methods:Wesystematically searched theMEDLINE 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.
