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Meta-Analysis
. 2024 May;61(5):543-553.
doi: 10.1007/s00592-024-02246-9. Epub 2024 Mar 10.

Effect of a multidisciplinary team approach in patients with diabetic foot ulcers on major adverse limb events (MALEs): systematic review and meta-analysis for the development of the Italian guidelines for the treatment of diabetic foot syndrome

Marco Meloni  1 , Laura Giurato  2 , Luca Monge  3 , Cesare Miranda  4 , Alessia Scatena  5 , Benedetta Ragghianti  6 , Giovanni Antonio Silverii  6 , Cristiana Vermigli  7 , Alessandro De Cassai  8 , Antonio Volpe  9 , Rodolfo Tramonta  10 , Gerardo Medea  11 , Corrado Bordieri  12 , Marco Falcone  13 , Laura Stefanon  14 , Andrea Bernetti  15 , Cristina Cappella  16 , Mauro Gargiulo  17 , Valentina Lorenzoni  18 , Germano Scevola  19 , Eugenio Stabile  20 , Roberto Da Ros  21 , Giuseppe Murdolo  7 , Eleonora Bianchini  7 , Francesco Gaggia  7 , Carlotta Gauna  22 , Francesco Romeo  23 , Matteo Apicella  5 , Michele Mantuano  5 , Matteo Monami  6 , Luigi Uccioli  24   2 ; Panel of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome and on behalf of SID and AMD
Affiliations
Meta-Analysis

Effect of a multidisciplinary team approach in patients with diabetic foot ulcers on major adverse limb events (MALEs): systematic review and meta-analysis for the development of the Italian guidelines for the treatment of diabetic foot syndrome

Marco Meloni et al. Acta Diabetol. 2024 May.

Abstract

The treatment of patients with diabetic foot ulcers (DFUs) is extremely complex, requiring a comprehensive approach that involves a variety of different healthcare professionals. Several studies have shown that a multidisciplinary team (MDT) approach is useful to achieve good clinical outcomes, reducing major and minor amputation and increasing the chance of healing. Despite this, the multidisciplinary approach is not always a recognized treatment strategy. The aim of this meta-analysis was to assess the effects of an MDT approach on major adverse limb events, healing, time-to-heal, all-cause mortality, and other clinical outcomes in patients with active DFUs. The present meta-analysis was performed for the purpose of developing Italian guidelines for the treatment of diabetic foot with the support of the Italian Society of Diabetology (Società Italiana di Diabetologia, SID) and the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD). The study was performed using the Grading of Recommendations Assessment, Development, and Evaluation approach. All randomized clinical trials and observational studies, with a duration of at least 26 weeks, which compared the MDT approach with any other organizational strategy in the management of patients with DFUs were considered. Animal studies were excluded. A search of Medline and Embase databases was performed up until the May 1st, 2023. Patients managed by an MDT were reported to have better outcomes in terms of healing, minor and major amputation, and survival in comparison with those managed using other approaches. No data were found on quality of life, returning-to-walking, and emergency admission. Authors concluded that the MDT may be effective in improving outcomes in patients with DFUs.

Keywords: Diabetes; Diabetic foot; Limb salvage; Multidisciplinary team.

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