Diabetic Foot Care: A Team Effort That Saves Lives

Diabetic foot ulcers (DFUs) and lower extremity amputations (LEAs) are serious issues. They can lower the quality of life and even threaten survival. They also cost a lot of money for healthcare and the economy. Guidelines suggest using a team approach, but not much is said about how cost-effective it is or how it works with primary care. The DEFINITE Care program in Singapore is a team effort. It involves both primary and tertiary care. It started in June 2020 and ran until 2022. The program included patients with DFUs. The outcomes measured included one-year minor and major LEAs, mortality, and LEA-free survival rates. It also looked at healthcare utilization, including the number of admissions, length of stay, and visits to primary care and hospitals. Quality of life (QoL) and Patient Reported Outcome Measures (PROMs) were assessed using the EuroQol Five-Dimensional Questionnaire and Diabetic Foot Ulcer Scale-Short Form.The results were compared to a group from before the program started. A cost-effectiveness analysis was also done. The program looked at different groups, including those without easy access to MDT clinics or podiatry, people who missed appointments, those over 80 years old, and patients with end-stage renal failure. The program included 2, 798 patients. The average age was 65. 7 years, and most were male (61. 4%). The program showed higher minor LEA rates and improved LEA-free survival. It also had fewer and shorter hospital stays and better QoL and PROMs. The program was more cost-effective than traditional care. Different groups had different outcomes. The DEFINITE Care program shows that a team effort between primary and tertiary care can save lives and limbs. It's effective and cost-efficient. It's a model that could be used in other places.