Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale Study, a prospective cohort study

  1. L. Prompers1,
  2. M. Huijberts1,
  3. J. Apelqvist1,
  4. E. Jude2,
  5. A. Piaggesi3,
  6. K. Bakker4,
  7. M. Edmonds5,
  8. P. Holstein6,
  9. A. Jirkovska7,
  10. D. Mauricio8,
  11. G. R. Tennvall9,
  12. H. Reike10,
  13. M. Spraul11,
  14. L. Uccioli12,
  15. V. Urbancic13,
  16. K. Van Acker14,
  17. J. Van Baal15,
  18. F. Van Merode16,
  19. N. Schaper1

Article first published online: 28 JUN 2008

DOI: 10.1111/j.1464-5491.2008.02445.x

Issue

Diabetic Medicine

Diabetic Medicine

Volume 25, Issue 6, pages 700–707, June 2008

Additional Information

How to Cite

Prompers, L., Huijberts, M., Apelqvist, J., Jude, E., Piaggesi, A., Bakker, K., Edmonds, M., Holstein, P., Jirkovska, A., Mauricio, D., Tennvall, G. R., Reike, H., Spraul, M., Uccioli, L., Urbancic, V., Van Acker, K., Van Baal, J., Van Merode, F. and Schaper, N. (2008), Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale Study, a prospective cohort study. Diabetic Medicine, 25: 700–707. doi: 10.1111/j.1464-5491.2008.02445.x

Author Information

  1. 1

    Division of Endocrinology , Department of Internal Medicine, University Hospital Maastricht, Maastricht, the Netherlands, Department of Endocrinology, University of Malmö, Malmö, Sweden,

  2. 2

    Diabetes Centre, Tameside General Hospital, Ashton under Lyne, UK,

  3. 3

    U.O. Semplice Piede Diabetico, Dipartimento di Endocrinologia e Metabolismo, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy,

  4. 4

    Chair IDF Consultative Section and International Working Group on the Diabetic Foot, Heemstede, the Netherlands,

  5. 5

    Diabetic Department, Kings College Hospital, London, UK,

  6. 6

    Copenhagen Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark,

  7. 7

    Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic,

  8. 8

    Department of Endocrinology & Nutrition, Hospital de Sant Pau, Autonomous University of Barcelona, Spain,

  9. 9

    Swedish Institute for Health Economics (IHE), Lund, Sweden,

  10. 10

    Innere Abteilung, Mariannen Hospital, Werl and

  11. 11

    Mathias-Spital, Diabetic Department, Rheine, Germany,

  12. 12

    Policlinico Tor Vergata, Department of Internal Medicine, Rome, Italy,

  13. 13

    Department of Endocrinology, University Medical Centre, Ljubljana, Slovenia,

  14. 14

    St Joseph Clinic, Department of Endocrinology, Bornen, Belgium,

  15. 15

    Department of Surgery, Twenteborg Ziekenhuis, Almelo and

  16. 16

    Department of Health Organization, Policy and Economics, Maastricht University, Maastricht, the Netherlands

* : Leonne Prompers, MD, Department of Internal Medicine, University Hospital Maastricht, P. Debeyelaan 25, PO Box 5800, 6202 AZ Maastricht, the Netherlands. E-mail: leonne.prompers@intmed.unimaas.nl

Publication History

  1. Issue published online: 28 JUN 2008
  2. Article first published online: 28 JUN 2008
  3. Accepted 29 January 2008

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article (HTML) Get PDF (412K)

Keywords:

  • diabetic foot;
  • PAD;
  • infection;
  • deliver of care

Abstract

Aims  To determine current management and to identify patient-related factors and barriers that influence management strategies in diabetic foot disease.

Methods  The Eurodiale Study is a prospective cohort study of 1232 consecutive individuals presenting with a new diabetic foot ulcer in 14 centres across Europe. We determined the use of management strategies: referral, use of offloading, vascular imaging and revascularization.

Results  Twenty-seven percent of the patients had been treated for > 3 months before referral to a foot clinic. This varied considerably between countries (6–55%). At study entry, 77% of the patients had no or inadequate offloading. During follow-up, casting was used in 35% (0–68%) of the plantar fore- or midfoot ulcers. Predictors of use of casting were male gender, large ulcer size and being employed. Vascular imaging was performed in 56% (14–86%) of patients with severe limb ischaemia; revascularization was performed in 43%. Predictors of use of vascular imaging were the presence of infection and ischaemic rest pain.

Conclusion  Treatment of many patients is not in line with current guidelines and there are large differences between countries and centres. Our data suggest that current guidelines are too general and that healthcare organizational barriers and personal beliefs result in underuse of recommended therapies. Action should be undertaken to overcome these barriers and to guarantee the delivery of optimal care for the many individuals with diabetic foot disease.

View Full Article (HTML) Get PDF (412K)