MULTIDISCIPLINARY APPROACH TO THE DIAGNOSIS AND TREATMENT OF INFECTIOUS COMPLICATIONS OF DIABETIC FOOT SYNDROME

Introduction. Diabetic foot syndrome is one of the severe complications of diabetes mellitus. This combination of pathological processes occurring in the foot is induced and aggravated by diabetes mellitus. Most often, diabetic foot syndrome is a consequence of angiopathy, neuropathy, osteopathy; it may be accompanied by infectious and ulcera-tive lesions, leading to amputation of the extremity.
The aim of the study. To assess the results of diagnosis and treatment of diabetic foot syndrome, following the intro-duction of a multidisciplinary approach.
Materials and methods. A retrospective analysis of 151 medical records of patients diagnosed with diabetic foot syndrome was carried out. There were 87 (57.6 %) men and 64 (42.4 %) women; the mean age was 63.6 ± 1.0 years. 
The most of patients (139 (92.1 %)) were diagnosed with type 2 diabetes mellitus.
Results. A multidisciplinary approach to the diagnosis and treatment of diabetic foot syndrome was achieved through the efforts of a team of specialists consisting of a surgeon, general practitioner, endocrinologist and vascular surgeon. 
The average glycemic level in the examined patients was higher than normal and amounted to 10.6 ± 0.4 mmol/l. In 111 of patients, the correction of carbohydrate metabolism was carried out with insulin, in the remaining observations – with tableted hypoglycemic drugs. All patients received treatment aimed at eliminating the main links in the pathogenesis of diabetic foot syndrome. Local conservative treatment was carried out in 66 cases, surgical treatment – in 85 cases. 
The majority of surgical interventions (40–47 %) were minor surgeries (preserving the supporting function of the leg), in 20 (23.5 %) patients surgeries were performed on the arteries, in 19 (22.4%) – high amputations (above the ankle joint), in 6 (7.1 %) – opening of foot phlegmon. The average duration of treatment for diabetic patients with diabetic foot syndrome was 17.1 ± 0.6 days.
Conclusion. Patients with diabetic foot syndrome were diagnosed with severe disorders of carbohydrate metabolism with the presence of angiopathy and neuropathy. A multidisciplinary approach to the diagnosis and treatment of diabetic foot syndrome makes it possible to identify the main links in pathogenesis and, based on existing protocols, to per-sonalize the treatment. This makes it possible to preserve the supporting function of the extremity in most patients and to reduce the number of high amputations.

1. Naeem Z. Burden of diabetes mellitus in Saudi Arabia. Int J Health Sci (Qassim). 2015;9(3):V-VI. DOI:10.12816/0024690

2. IDF Diabetes Atlas 2021-10th ed. [(accessed on 26 September 2023)]. Available online: https://diabetesatlas.org

3. Ogurtsova K, da Rocha Fernandes JD, Huang Y, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017;128:40-50. DOI:10.1016/j.diabres.2017.03.024

4. American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917-928. DOI:10.2337/dci18-0007

5. Shukla V, Fatima J, Ali M, Garg A. A Study of Prevalence of Peripheral Arterial Disease in Type 2 Diabetes Mellitus Patients in a Teaching Hospital. J Assoc Physicians India. 2018;66(5):57-60.

6. Ziegler-Graham K, MacKenzie EJ, Ephraim PL. et al. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil. 2008;89(3):422-429. DOI:10.1016/j.apmr.2007.11.005

7. Humphries MD, Brunson A, Li C-S, Melnikow J, Romano, PS. Amputation trends for patients with lower extremity ulcers due to diabetes and peripheral artery disease using statewide data. J Vasc Surg. 2016;64(6):1747-1755.e3. doi:10.1016/j.jvs.2016.06.096

8. Walicka M, Raczyńska M, Marcinkowska K, LisickaI, Czaicki A, Wierzba W, Franek E. Amputations of lower limb in subjects with diabetes mellitus: reasons and 30-day mortality. J Diabetes Res. 2021 Jul 24;2021:8866126. DOI:10.1155/2021/8866126

9. Matijević T, Talapko J, Meštrović J, Matijević M, Erić S, Erić I, Škrlec I. Understanding the multifaceted etiopathogenesis of foot complications in individuals with diabetes. World J Clin Cases. 2023 Mar 16;11(8):1669-1683. DOI: 10.12998/wjcc.v11.i8.1669

10. Armstrong DG, Tan T-W, Boulton AJM, Bus SA. Diabetic foot ulcers: a review. JAMA. 2023 Jul 3;330(1):62-75. DOI: 10.1001/jama.2023.10578

11. McDermott K, Fang M, Boulton AJM, Selvin E, Hick CW. Etiology, epidemiology, and disparities in the burden of diabetic foot ulcers. Diabetes Care. 2023;46(1):209-221. DOI:10.2337/dci22-0043

12. Lavery LA, Armstrong DG, Wunderlich RP. et al. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29(6):1288-1293. DOI:10.2337/dc05-2425

13. Yan X, Song J-F, Zhang L, Li X. Analysis of risk factors for multidrug-resistant organisms in diabetic foot infection BMC Endocr Disord. 2022 Feb 21;22(1):46. DOI: 10.1186/s12902-022-00957-0

14. Wada J, Makino H. Innate immunity in diabetes and diabetic nephropathy. Nat Rev Nephrol. 2016;12(1):13-26. DOI:10.1038/nrneph.2015.175

15. Zhou T, Hu Z, Yang S, Sun L, Yu Z, Wang G. Role of Adaptive and Innate Immunity in Type 2 Diabetes Mellitus. J Diabetes Res. 2018;2018:7457269. DOI:10.1155/2018/7457269

16. Buggy A, Moore Z. The impact of the multidisciplinary team in the management of individuals with diabetic foot ulcers: a systematic review. J Wound Care. 2017;26(6):324-339. DOI:10.12968/jowc.2017.26.6.324

17. Crawford F, Cezard G, Chappell FM et al. A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS). Health Technol Assess. 2015;19(57):1-210. DOI: 10.3310/hta19570

18. Bandyk DF. The diabetic foot: Pathophysiology, evaluation, and treatment. Semin Vasc Surg. 2018;31(2-4): 43-48. DOI: 10.1053/j.semvascsurg.2019.02.001

19. Lipsky BA, Senneville É, Abbas ZG et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020Mar;36Suppl 1:e3280. DOI: 10.1002/dmrr.3280

20. Lepäntalo M, Apelqvist J, Setacci C et al. Diabetic foot. Eur J Vasc Endovasc Surg. 2011;42 Suppl 2:60-74. DOI: 10.1016/S1078-5884(11)60012-9

21. Kalish J, Hamdan A. Management of diabetic foot problems. J Vasc Surg. 2010;51(2):476-486. DOI:10.1016/j.jvs.2009.08.043

22. Bus SA, Lavery LA, Monteiro-Soares M et al. International Working Group on the Diabetic Foot. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36 Suppl 1:e3269. DOI: 10.1002/dmrr.3269

23. Hingorani A, LaMuraglia GM, Henke P, et al. The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg 2016;63(2 Supp):3S-21S DOI:10.1016/j.jvs.2015.10.003

24. Chuter V, Quigley F, Tosenovsky P et al. Australian Diabetes-related Foot Disease Guidelines & Pathways Project. Australian guideline on diagnosis and management of peripheral artery disease: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease. J Foot Ankle Res. 2022;15(1): 51. DOI: 10.1186/s13047-022-00550-7

25. Lipsky BA, Berendt AR, Cornia PB et al. Infectious Diseases Society of America. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12): e132-e173. DOI: 10.1093/cid/cis346

26. Dinh T, Snyder G, Veves A. Current techniques to detect foot infection in the diabetic patient. Int J Low Extrem Wounds 2010;9(1): 24-30. DOI:10.1177/1534734610363004

27. Lavery LA, Oz OK, Bhavan K, Wukich DK. Diabetic Foot Syndrome in the Twenty-First Century. Clin Podiatr Med Surg. 2019;36(3):355-359. DOI:10.1016/j.cpm.2019.02.002

28. Bus SA, Armstrong DG, Gooday C, J et al. International Working Group on the Diabetic Foot (IWGDF). Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36 Suppl 1:e3274. DOI: 10.1002/dmrr.3274

29. Borys S, Hohendorff J, Koblik T et al. Negative-pressure wound therapy for management of chronic neuropathic noninfected diabetic foot ulcerations – shortterm efficacy and long-term outcomes. Endocrine. 2018;62(3): 611-616. DOI:10.1007/s12020-018-1707-0

30. Edwards J, Stapley S. Debridement of diabetic foot ulcers. Cochrane Database Syst Rev. 2010; 2010(1): CD003556. DOI: 10.1002/14651858.CD003556.pub2

31. Everett E, Mathioudakis N. Update on management of diabetic foot ulcers. Ann N Y Acad Sc. 2018;1411(1):153-165. DOI:10.1111/nyas.13569