Background Diabetes is associated with a significant risk of LEA (lower extremity amputation). LEA rates vary between communities, 46–9,600 per 105 people with diabetes, for many reasons. The effects of clinical and socio-demographic risk factors on the occurrence of a LEA have been well documented in people with diabetes. However, the effect of patient contact with a podiatrist on the prevention of LEA in people with diabetes is less well explored. The objective of this study was to determine if contact with a podiatrist prevents the occurrence of lower extremity amputation in people with diabetes.
Methods We conducted a systematic review of available published literature on the effect of contact with a podiatrist on the prevention of lower extremity amputation in people with diabetes. Eligible studies were identified through searches of PUBMED, CINAHL, EMBASE (Excerpta Medica), and Cochrane databases. Reference lists of all relevant papers were reviewed for additional eligible articles. Randomised and non-randomised studies of the effect of contact with a podiatrist on risk of LEAs in people with diabetes (type 1 or 2) were included. Two reviewers independently assessed titles, abstracts, and full articles to identify eligible studies. Meta-analysis was performed separately for randomised and non-randomised studies.
Results Four hundred and ninety-nine titles were retrieved from searches of electronic databases. Duplicates (138) were removed and 361 titles/abstracts were reviewed. Nineteen papers were considered for review after initial screening of titles and abstracts. Three further studies were identified as potentially eligible from reference checking. After reviewing the full text articles, 6 studies met the inclusion criteria. The identified studies were heterogeneous in design (2 RCTs and 4 cohort studies) and included people with diabetes at both low and high risk of amputation. In a meta-analysis of available data from RCTs, the pooled RR of LEA was 1.4 (95% CI 0.2–9.3). The pooled RR from available cohort studies suggested a protective effect of podiatry but the estimate was unreliable, RR of 0.7 (95% CI 0.09–5.68).
Conclusion There is very limited data available on the effect of contact with a podiatrist on risk of LEA in people with diabetes. Further research in this area is warranted. An adequately powered RCT with a reasonably homogenous population regarding risk profiles would be the ideal way to answer this question if possible. A systematic review looking at the effect of podiatry as part of a multidisciplinary foot team on the risk of LEA in people with diabetes would also be prudent.
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