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EBM verdict
Primary care
Multidisciplinary teams effect on major amputations in patients with diabetes
  1. Carl Heneghan,
  2. Kamal R Mahtani
  1. Centre for Evidece-Based Medicne, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Professor Carl Heneghan, Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; carl.heneghan{at}phc.ox.ac.uk

https://doi.org/10.1136/bmjebm-2020-111342

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    Patients with diabetic foot ulcers are at high risk of lower leg amputations, which have a considerable impact on their quality of life. Identifying strategies to reduce this risk are a priority. Growing evidence suggests that supporting these patients through multidisciplinary teams (MDTs) may reduce the risk of amputations. A new systematic review gives insights into how these teams should be composed.

    The global prevalence of diabetes and its associated complications has risen substantially, with 153 million people affected in 1980, rising to 347 million in 2008.1 The macrovascular complications associated with diabetes, including cardiovascular disease (CVD), stroke and peripheral arterial disease (PAD), cause substantial morbidity and mortality. PAD may lead to non-healing injuries including ulcers, persistent infection, gangrene and act as a significant risk factor for lower-leg amputation. The incidence of non-traumatic amputations is at least 15 times greater in those with diabetes.2

    Annually, approximately 1%–4% of patients with diabetes develop a foot ulcer (about 15% will have at least one-foot ulcer in their …

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    Footnotes

    • Twitter @carlheneghan, @krmahtani

    • Contributors CH wrote the first draft, KRM provided edits. Both authors approved the final draft.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

    • Competing interests CH and KRM are supported by the NIHR School for Primary Care ResearchEvidence Synthesis Working group (NIHR SPCR ESWG project 390). CH isalso supported by the NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, an NIHR Senior Investigator and Editor in Chief of BMJ Evidence-Based Medicine. KRM is an associate editor of BMJ EBM.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.