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Diabetic foot syndrome too often leads to amputation
Diabetes is a common complaint, the particularly unpleasant consequences of which is the so-called diabetic foot syndrome (DFS). A foot amputation is often performed on this. However, the stressful intervention could be prevented in many cases, emphasizes the German Society for Internal Medicine (DGIM) in a press release on the occasion of the 123rd Internist Congress in Mannheim at the end of April.
According to the DGIM experts, a large part of the amputations in diabetic foot syndrome could be avoided if the patients were cared for early on by an interdisciplinary network of competent experts. Every diabetes patient should also be instructed early on to have their feet closely inspected, adds Professor Dr. med. Petra-Maria Schumm-Draeger, Chair of DGIM and President of the 123rd Internist Congress.
Amputation the last option
In diabetes, the nerves and blood vessels in the feet are sometimes so severely damaged by the high blood sugar level that “even small wounds heal poorly, become infected and sometimes expand to the bone,” explain the DGIM experts. The symptoms are described as diabetic foot syndrome. In the end, often only the amputation remains to get the wound under control, according to the DGIM announcement.
Four fifths of the interventions avoidable
"After all, 70 percent of the amputations that are performed in Germany every year - that is around 40,000 - concern patients with diabetes mellitus," reports the DGIM. According to Professor Dr., four fifths of these interventions would be Ralf Lobmann, Medical Director of the Clinic for Endocrinology, Diabetology and Geriatrics at the Stuttgart Clinic, but avoidable with a suitable treatment. To do this, however, medical specialists such as diabetologists and vascular surgeons would have to work closely with representatives of other health professions such as podiatrists, wound assistants and orthopedic shoe technicians.
Interdisciplinary collaboration required
First of all, an optimal metabolic setting and the consequent relief of the affected foot are planned for the treatment, reports the DGIM. In the case of infections, targeted treatment with antibiotics remains essential. "If blood flow to the foot is severely restricted, individual vessels must be expanded by balloon catheterization or bypassed by a vascular bypass," explains Professor Dr. Lobmann continues. In order to avoid relapses, it is also important to adjust the shoes optimally to the (remaining) foot and to avoid pressure points.
Number of amputations significantly reduced
The stressful amputations could be avoided in many cases if patients were cared for by such an interdisciplinary network of competent experts, reports Prof. Lohmann. An initial data analysis had shown that the concept is quite successful and that only around 3.1 percent of around 18,500 DFS patients who were treated in certified centers between 2005 and 2012 received a so-called high amputation (foot amputated above the ankle). This value is well below the generally accepted rate of 10 to 20 percent. According to the DGIM, an amputation below the ankle was required in 17.5 percent of the cases.
Inspect your own feet regularly
"The figures make it clear that many amputations can be avoided by providing care in specialized centers," emphasizes Professor Lobmann. However, those affected are also required for this. Because on the one hand they should recognize the warning signals and on the other hand they should optimally inform their doctor about their own illness. Every diabetic patient should regularly inspect their own feet, the experts explain. Because the wounds usually remain painless and are therefore often not noticed until late, ”continued the DGIM chair, Prof. Schumm-Draeger. By the time a doctor or podiatrist sees them, it may already be too late.
Establish interdisciplinary care structures
As soon as the first signs of the DFS are available, interdisciplinary treatment of the patients is essential to reduce the risk of amputation, the DGIM experts emphasize. Professor Lobmann is therefore working in a corresponding working group of the German Diabetes Society to establish and certify interdisciplinary care structures for the treatment of the diabetic foot in Germany. "We hope that this will reduce the alarmingly high number of amputations," emphasizes the diabetologist. (fp)