Background/Aims: Since 2005, recognized Belgian multidisciplinary diabetic foot clinics (MDFCs) participate to biennial audit-feedback cycles, allowing to study the epidemiology of diabetic foot ulcers (DFU) and monitor/improve quality of care. We investigated how patient and foot characteristics, treatment and outcome evolved between 2008 and 2020.
Methods: Data were cross-sectionally collected between 2008 and 2020. Recognized MDFCs included the first 52 patients with a new DFU of Wagner 2 or higher during the audit period. Person and ulcer characteristics were recorded at baseline together with treatment and outcome during a 6-month follow-up period. A neutral weighting was applied to all variables. Evolution over time was studied in a repeated cross-sectional way using Generalized Estimating Equations (SAS9.4).
Results: The number of people with a new DFU included were 985 in 2008 (20 MDFCs) and increased to 1.579 in 2020 (35 MDFCs). Patients became older (2008: 68.2±0.4 years; 2020: 70.1±0.3 years; p<0.0001), had a longer median (P25-P75) diabetes duration (2008: 14.2 (7.5-23.4) years; 2020: 16.3 (9.5-24.5) years; p=0.0002) and more often type 2 diabetes (2008: 87.8%; 2020: 91.2%; p=0.0013). Comorbidity rates were high. Presentation to the MDFC on the patient’s own initiative strongly elevated over time (collected since 2011: 20.6%; 2020: 35.1%; p<0.0001). Moreover, median (P25-P75) patient-reported presentation delay reduced significantly from 4 (2-8) weeks in 2008 to 3 (1-8) weeks in 2020 (p=0.0134). Proportion of severe DFU (SINBAD≥3) diminished across the audits (2008: 91.6%; 2020: 82.3%; p=0.0115). Proportion of patients receiving offloading (collected since 2011: 74.6%; 2020: 63.2%; p=0.4750), undergoing a revascularization when having critical limb ischemia (2008: 66.4%; 2020: 67.0%; p=0.7860), minor amputation (2008: 16.8%; 2020: 21.1%; p=0.1636) or major amputation (2008: 3.6%; 2020: 2.9%; p=0.5882) remained unchanged over time. Nonetheless, healing after 6 months follow-up decreased slightly from 47.2% in 2008 to 43.8% in 2020 (p=0.0296). Inter-center variability remained high throughout time.
Conclusions: Despite the positive evolution of faster presentation to the MDFC with less severe DFU, the outcome did not change over time and even a slight decrease in healed DFU after 6 months could be observed. A negative trend towards less offloading might be an underlying cause.
