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Competing Interests: S.Morbach has been active in the National Advisory Board DFU of URGO GmbH for the past 3 years and has received corresponding fees. In the past 3 years, he has received research funding in the sense of monetary benefits (equipment and materials) from the company Reapplix AS. He is a visiting researcher at the Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf.R. Lobmann has received research funding (personally or at his personal disposal) either directly or in the form of monetary benefits (personnel, equipment, etc.): Urgo (E2-Sub-study). As a speaker he received a fee or as a passive participant he received a reimbursement of costs (travel or accommodation costs, paid participation fees): Honorary speaker: Böhringer Ingelheim, Daiichi-Sankyo, GWT-TUD GmbH, Lilly, Novo Nordisk, SanofiAventis, URGO, Wörwag Pharma. Reimbursement of costs: Abbott, Urgo, Wörwag. He has been a paid consultant/internal training consultant or similar for: Abbott, URGO, Wörwag Pharma. Membership and position in scientific societies/professional associations and possibly other associations relevant to this training measure: Member of the board of the ADBW, spokesman of the regional societies of the DDG, member of the Diabetes Advisory Board of the State Government of Baden Württemberg, delegate for D-Foot International, member of the board of the German Diabetes Society (DDG; 2016–2020), spokesman of the DDG Working Group on the Diabetic Foot (2010–2020).A. Risse has been active within the last 3 years in advisory boards of URGO GmbH and Neubourg Skin Care and has received corresponding fees. For lectures and training activities he received fees from the companies URGO GmbH and Paul Hartmann AG. He is chairman of the Pharmacists in Diabetology Commission.M. Eckhard has worked for the following companies within the last 3 years and has received research funding in the sense of monetary benefits (equipment and materials) from: Reapplix AS. As a speaker, consultant or author, he has received fees or expense allowances from the following companies or institutes within the last 3 years: Astra-Zeneca, Boehringer-Ingelheim, Diabetologen Hessen e.G., Landesärztekammer Hessen (Hesse State Medical Council), Lilly Deutschland, Novo Nordisk, Schwarzkopf Institute, Springer-Verlag. Accompanying offices: Chairman of the Hessian Diabetes Society Chairman of the Hessian Diabetes Society e.V. (HDG, Regional Society of DDG), spokesman of the Diabetic Foot Working Group of the DDG (since 2020), Professional status: Medical Director of the University Diabetes Center at the University Hospital Giessen and Marburg GmbH (UKGM, Giessen location), Chief Physician of the GZW Diabetes Clinic Bad Nauheim.H. Reike discloses that the Mariannen-Hospital has received support for events organized by him from the companies Novo Nordisk Deutschland, Lilly Deutschland, Beurer, Emmerich.M. Spraul has worked for the following companies within the last 3 years and has received corresponding fees: Lilly Deutschland (lectures and consulting), Novo Nordisk (lectures and consulting), Neubourg Skin Care (lectures and consulting). M. Spraul discloses that the Mathias-Spital has received support from the companies Novo Nordisk Deutschland and Neubourg Skin Care for events organized by him.G. Rümenapf and E. Müller have no conflicts of interest.

Systematic Review Registration Number: PROSPERO CRD4201501780.

Background: Patients with neuroischemic diabetic foot syndrome (DFS) may need arterial revascularization, minor amputations, débridements as well as meticulous wound care. Unfortunately, postoperative outpatient care is frequently inadequate. This is especially true for Germany, where the in- and outpatient sectors are funded and managed separately, with poor communication between the two. Thus, many patients may be readmitted to the hospital following successful treatment and discharge. In an attempt to overcome these problems, we looked at whether an integrated case management (CM) system for outpatient care according to in-hospital standards might improve patients care and avoid readmissions. In addition we analyzed the length of hospital stay (LOS) as well as hospital costs., Patients and Methods: In this retrospective cohort study patients with DFS, bypass surgery and foot surgery after implementation of the CM (study group; n = 376) were compared with a matched historic control group (HCG; n = 190) including the flat rate revenues (G-DRG K01B). Following a standardized assessment, integrated trans-sectoral CM care was offered to 116 patients (CMP)., Results: The proportion of patients who were readmitted to hospital was reduced in CMP compared to HCG (8.8 vs. 16.4 %; p < 0.01), with consequent reduction of case consolidations (9.7 % versus 17.8 %, p < 0.001). Although initially, the mean LOS was higher in the CMP patients, the reduction in readmissions meant that this integrated CM program improved the hospital's economic situation., Conclusions: A hospital-based integrated CM system significantly reduces the hospital readmissions in patients with neuroischemic DFS following bypass surgery, with lower hospital costs.

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The diabetic foot is a lifelong disease. The longer patients with diabetes and foot ulcers are observed, the higher the likelihood that they will develop comorbidities that adversely influence ulcer recurrence, amputation and survival (for example peripheral arterial disease, renal failure or ischaemic heart disease). The purpose of our study was to quantify person and limb-related disease progression and the time-dependent influence of any associated factors (present at baseline or appearing during observation) based on which effective prevention and/or treatment strategies could be developed. Using a nine-state continuous-time Markov chain model with time-dependent risk factors, all living patients were divided into eight groups based on their ulceration (previous or current) and previous amputation (none, minor or major) status. State nine is an absorbing state (death). If all transitions are fully observable, this model can be decomposed into eight submodels, which can be analyzed using the methods of survival analysis for competing risks. The dependencies of the risk factors (covariates) were included in the submodels using Cox-like regression. The transition intensities and relative risks for covariates were calculated from long-term data of patients with diabetic foot ulcers collected in a single specialized center in North-Rhine Westphalia (Germany). The detected estimates were in line with previously published, but scarce, data. Together with the interesting new results obtained, this indicates that the proposed model may be useful for studying disease progression in larger samples of patients with diabetic foot ulcers. [ABSTRACT FROM AUTHOR]