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Meta-Analysis
. 2021 Apr;35(4):107837.
doi: 10.1016/j.jdiacomp.2020.107837. Epub 2020 Dec 31.

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  1 , Jorge Vale-Lima  2 , João Martiniano  3 , Sofia Pinheiro-Torres  4 , Vanessa Dias  5 , Edward J Boyko  6
Affiliations
Meta-Analysis

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 et al. J Diabetes Complications. 2021 Apr.

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.

Keywords: Diabetic foot; Foot ulcer; Lower Extremity Amputation; Meta-analysis, Risk, Systematic Review.

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Conflict of interest statement

Declaration of competing interest VA Puget Sound provided support for Dr. Boyko's involvement in this research. Dr. Boyko received payment from Bayer AG to attend advisory board meetings. The other authors have no financial disclosures. The authors declare that they have no conflict of interest.

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