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Objective To construct an evaluation index for the post competency of case managers of diabetes foot, and to provide an objective and scientific theoretical basis for the selection, training and assessment of case managers of diabetes foot. Methods Based on the iceberg model of post competency, through literature review and semi-structured in-depth interview and consultation with 10 specialized nurses from different departments in the hospital, the primary index of post competency evaluation for case managers of diabetic foot was established, and 19 experts were consulted by Delphi expert letter method for three rounds, and the index system of post competency evaluation for case managers of diabetic foot was established in combination with the actual situation and expert opinions of the hospital. Results After three rounds of consultation, the questionnaire response rate was 100%, with Kendall′s harmony coefficients of 0. 136-0. 270, 0. 182-0. 235, 0. 184-0. 341, and expert authority coefficients of 0. 926, 0. 955, and 0. 961, respectively. Finally, a competency evaluation index system for diabetes foot case managers was formed with five first level indicators（nursing decision-making ability, interpersonal communication ability, quality supervision ability, education guidance ability, scientific research innovation ability), 13 second level indicators, and 69 third level indicators. Conclusion The competency evaluation index system of diabetes foot case managers constructed in this study is scientific, practical and reliable, which can provide quantifiable index reference for the selection, training, assessment and evaluation of diabetes foot case managers. [ABSTRACT FROM AUTHOR]

Background Foot complications are common in people with diabetes mellitus (DM), leading to increased health care utilization, heightened mortality risk, and notable recurrence rates even after treatment. This retrospective cohort study aimed to investigate the impact of repeated occurrence of DM-related foot complications on the risk of all-cause mortality and to identify the potential risk factors associated with repeated events. Methods People with DM admitted with foot complications (ulcer, skin and soft tissue infection, or osteomyelitis) from 2012 to 2014 were identified from Taiwan's National Health Insurance Research Database, with a 3-year follow-up for repeated events. We categorized the study subjects based on their cumulative number of hospital admissions with foot complications. Logistic regression was conducted to explore the potential risk factors associated with repeated diabetic foot events. Kaplan-Meier curves and Cox proportional hazard models were used to examine the associations between repeated diabetic foot events and all-cause mortality. Results In this study, 28 754 eligible individuals were enrolled and classified into 3 groups: no repeated diabetic foot events (76.1%), 1 repeated event (16.0%), and 2 or more repeated events (7.9%). Logistic regression revealed that advanced age, male sex, congestive heart failure, dyslipidemia, hypertension, nephropathy, retinopathy, neuropathy, peripheral vascular disease, diabetes-related preventable hospitalizations, and outpatient visits due to diabetic foot were significantly associated with repeated events of diabetic foot complications. Compared with those with no repeated events, the adjusted hazard ratios for all-cause mortality were 1.26 (95% CI, 1.19–1.34) for 1 repeated event and 1.36 (95% CI, 1.26–1.47) for 2 or more repeated events. Conclusions The significant association between repeated diabetic foot and elevated mortality risk highlights the critical necessity for proactive and targeted patient care within clinical practice. More research to delve into the predictive factors related to the repeated occurrence of diabetic foot is needed to provide additional insights for prevention strategies. [ABSTRACT FROM AUTHOR]

Aims: To determine the risk factors associated with amputations in hospitalized patients with diabetic foot infection. Methods: this is a prospective study conducted at a tertiary care hospital in Panama between January 2010 and December 2016. We included all patients admitted to the hospital with diabetes and diabetic foot infection. A total of 351 patients were included, and a survey to assess for demographic and clinical factors was completed prospectively until discharge. The outcome was lower limb amputation. Results: Sixty-one participants (17.4 %) required a lower limb amputation, and 22 (36.1 %) were major amputations. Several factors were associated with amputation in the univariate analysis: history of foot infection, history of amputation, peripheral arterial disease, a major index ulcer area, duration of the index ulcer >30 days, Grade III 3D severity according to Texas scale, a greater IDSA classification, the presence of necrosis and osteomyelitis. Nevertheless, multiple logistic regression revealed significant relationships between amputations and necrosis (P

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Objective To explore the clinical effect of PRP on refractory ulcer of diabetes foot on the basis of routine treatment. Methods Sixty-four patients who suffered from diabetes foot and treated in our hospital from January to December 2020 were divided into the routine treatment group (44 cases) vs PRP plus routine treatment group (20 cases, using liquid or gel PRP for diversified treatment) according to a simple random sampling method. The general conditions of the two groups were evaluated to compare the wound surface, wound healing rate, treatment time, wound healing speed rate, adverse reactions and healing conditions after the treatment. Results The wound surface[0.05(0.00, 0.70)vs 0.35(0.00, 4.54)], wound healing rate[0.99(0.84, 1.00)vs 0.80(0.26, 1.00)] and wound healing speed rate[0.16(0.04, 0.27)vs 0.06(0.01, 0.18)] in PRP group were significantly higher than those in routine treatment group (P0.05), so was the adverse reactions to treatments[0(0/20)vs 2.27(1/44)](P>0.05). The response rate[100(20/20)vs 61.36(27/44)] of PRP group was significantly better than that of routine group, and the difference was statistically significant (P

Abstract Background Diabetes foot self-care is one of the self-management behaviors of diabetic patients leading to a reduction in the incidence of pressure ulcers and amputation. Having a valid, reliable, simple and comprehensive tool is essential in measuring the self-care behavior of diabetic patients. The aim of this study was to evaluate the psychometric properties of the Farsi version of the diabetes foot self-care bahavior scale (DFSBS) in Iran. Methods In this cross-sectional and methodological study, 500 patients with type 2 diabetes were recruited by convenience sampling. Construct validity was assessed by exploratory factor analysis (over 300 patients) and confirmatory factor analysis (over 200 patients). Internal consistency was calculated by Cronbach’s alpha coefficient and its stability was calculated by intraclass correlation coefficient (ICC). Results In the exploratory factor analysis, two self-care factors related to feet and shoes were extracted which had specific values of 38.49 and 1.24, respectively, and were able to account for 56.22% of the total self-care variance of diabetes foot. Confirmatory factor analysis had excellent fit model. The internal consistency and ICC of the whole instrument were 0.83 and 0.791 (95% CI: 0.575–0.925; P

Introduction: Diabetic foot ulcers (DFUs) stand out as a prevalent and debilitating condition. Furthermore, the progression of diabetes-related hyperglycemia and associated conditions such as peripheral arterial disease exacerbates the risks of DFUs, including complications like infection and gangrene. Given the significant burden of DFUs, there is a pressing need to improve preventive and therapeutic strategies. This study investigates the clinical profiles of patients with DFUs, including the importance of smoking and intermittent claudication, evaluates management strategies based on the vascular status assessed through Doppler scans, and provides insights into the importance of ankle-brachial pressure index (ABPI) and toe brachial index (TBI) values, which play a vital role in predicting and managing ulcer healing outcomes, highlighting the importance of vascular assessment in treatment planning., Aim: The study aims to assess the clinical profile of patients with DFUs based on their vascularity status using Doppler scans, predict the outcome of the ulcer using indexes like ABPI and TBI values, and decide on further management., Materials and Methods: This prospective study was conducted over 24 months, from August 2022 to July 2024, at the Department of General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune. The study included 50 patients presenting with DFUs. Approval was obtained from the Institutional Ethics Committee, and informed consent was obtained from all participants. A detailed history was taken, including the history of smoking and intermittent claudication, and a thorough examination of the ulcer was performed. HbA1c levels were measured, Doppler scans of the lower limbs were done, and the ABPI and TBI values were calculated. Management strategies were determined based on the assessed vascular status, leading to either medical or surgical interventions., Results: Twenty-one (42%) patients who presented with DFUs had a positive history of intermittent claudication, demonstrating a significant association between the history of intermittent claudication and the Doppler findings. Thirty-seven (74%) patients gave a positive history of smoking, which revealed a significant association between the history of smoking and Doppler findings. Thirty-eight (76%) patients had an ABPI of <0.9, out of which 33 (66%) patients showed an improved outcome of the ulcer after necessary management. There is also a statistically significant association between the ABPI and Doppler findings. Sixteen (32%) of patients had a TBI of <0.65, of which all showed an improvement. There is a highly significant association between TBI and the Doppler findings., Conclusion: This study concludes that integrated routine assessment of ABPI and TBI into DFU management protocols is necessary to guide treatment decisions and monitor response to therapy. Treatment and prevention of diabetes-related complications affecting the lower extremities require a dedicated interdisciplinary approach., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Subcommittee issued approval I.E.S.C./PGS/2022/76. Before the study started, ethics approval from the Research and Recognition Committee under the Faculty of Medicine of Dr. D. Y. Patil Medical College, Hospital and Research Centre was obtained. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Parekh et al.)

Objective To conduct a cost-utility analysis of the technology lipido-colloid (TLC) with nano-oligo saccharide factor (NOSF) dressing (TLC-NOSF dressing) versus Non-NOSF advanced wound care dressing in the treatment of diabetic foot ulcer (DFU). Methods This study established Markov model based on the development process of DFU disease. An initial cohort of 10 000 patients with DFU were assigned to the TLC-NOSF dressing group and the non-NOSF dressing group. Deducted the evaluation model for 20 years (40 cycles), inputted efficacy, cost and health utility parameters, which were obtained by literature review and expert consultation, to evaluate the long-term cost-effectiveness of two dressing groups and implement economic evaluation [survival cohort analysis, cost-effectiveness analysis, sensitivity analysis (univariate sensitivity analysis, subgroup analysis, and probabilistic sensitivity analysis)]. Results The results showed that after 20 years of modeling, survival rate of NON-NOSF dressing group was 24.59%, while TLC-NOSF dressing group was 27.42%. TLC-NOSF dressing group has lower cost (NON-NOSF dressing group was 168 069.56 yuan, TLC-NOSF dressing group was 156 881.90 yuan, The latter saved 11 187.66 yuan), higher health utilities [quality-adjusted life year (QALY) of NON-NOSF dressing group was 4.220 years, QALY of TLC-NOSF dressing group was 4.471 years, The latter improved 0.251 years], better cost-effectiveness [incremental cost-effectiveness ratio (ICER) was -44 520.838 yuan/QALY]. The results of sensitivity analysis showed that utility of healed state, TLC-NOSF dressing price, DFU to health state transition probabilities of the study group, price of Non-NOSF advanced wound care dressing had a great impact on the results of ICER. Conclusions At current price levels, compared with Non-NOSF dressing, TLC-NOSF dressing is more economically efficient in the treatment of DFU. [ABSTRACT FROM AUTHOR]

Objective. To study the issues of anesthetic management of surgical interventions in patients with diabetic foot syndrome. In our work, the analysis of specialized literature and research on the anesthetic management of surgical interventions in patients with diabetic foot syndrome was performed. Most often diabetic foot syndrome (DFS) occurs in patients with severe diabetes and co-morbidities, and there are strict requirements for anesthesia safety for surgical interventions in DFS patients and minimal impact on carbohydrate metabolism and CNS functions. The results of the literature review have shown that preference is given to the regional methods of anesthesia as they allow patients to maintain a dietary pattern and insulin regimen, to reduce the risk of intraoperative complications in concomitant coronary artery disease, heart failure, cardiac arrhythmias, hypertension, renal failure, and pulmonary embolism incidence. Taking the above into account as well as cost-effectiveness and availability of modern navigation tools (for example, USD) for regional anesthesia performing, make it the most appropriate when choosing anesthesia technique in DFS patients. Conclusions. An improvement of the treatment effectiveness as a whole and patient’s long-term quality of life must be taken into consideration when choosing an anesthesia method. Based on foreign and domestic studies, it can be argued that regional anesthesia is very beneficial and best for anesthesiologists and surgeons and, above all, for patients with DFS.

Diabetic foot is a serious complication that causes lower extremity amputations. The aim of this study was to identify the patient’s awareness about risk factors for diabetic foot disease and to explore the knowledge and foot care practices among diabetic patients in a Saudi population. This cross-sectional study was conducted in King Khalid University Hospital (KKUH), King Abdulaziz University Hospital (KAUH), King Fahad Medical City, National Guard Hospital, Military Hospital, and Prince Salman Hospital capital city of Saudi Arabia. Patients were eligible if they had diabetes foot disease, signed the consent form, and completed the questionnaire. We selected 350 patients from different hospitals between November-2011 and April-2012. The majority of patients (68%) were selected from King Saud University hospitals. The mean age of patients was 50.87 ± 15.9 years with a range of 20–90 years. The majority of patients were male (64.3%) and had a family history of hypertension (55.4%), high total cholesterol (58.6%), and other diabetes (58.9%). A family history of smoking, a major risk factor for diabetic foot, was found in 20.3% of cases. Sixty percent of the patients were using oral medications, 27.1% were using insulin therapy, 10% were using both oral and insulin therapies, and 10% were on diet. In our study, 19.4% of participants were illiterate while 80.6% had a high school or university level education. Our findings also revealed that some patients had a lack of knowledge concerning diabetic foot disease and future complications. Patients are unaware of the risk factors for diabetes foot and practice poor foot care. Awareness programs should be mandatory in all hospitals and diabetes clinics to help compensate for the lack of awareness and lack of podiatric educational services. Such programs may decrease the risk of diabetes foot disease. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot ulceration is receiving more attention because of its high amputation and mortality rate. It is essential to establish the frequency of amputations in people with diabetes after any change to the management of diabetic foot care. The present study aim to compare the frequency of lower-extremity amputations in patients with diabetes foot ulcer over a ten-year period. Methods: Six hundred forty eight patients with diabetes foot ulcer were retrospectively studied from 2004 to 2013. The clinical features, laboratory results and the lower-extremity amputations were recorded. Major amputation was defined as amputations above the ankle while minor amputation was amputations below the ankle in the present study. Results: Patients with diabetic foot ulcer were old (age 66.96 ± 11.96 years), with a long duration of diabetes (10.30 ± 6.94 years), high HbA1c (9.19 ± 2.62 %), SBP (144.05 ± 24.18 mmHg), DBP (79.53 ± 11.88 mmHg), LDL-C (2.71 ± 0.93 mmol/L) and had great frequency of neuropathy (62.7 %), retinopathy (45.0 %), nephropathy (39.5 %) and PAD (33.2 %). From 2004 to 2013, the frequency of all lower-extremity amputations is 12.0 % (5.2 % major amputation, 6.8 % minor amputation). The frequency of major amputations decreased from 9.5 % in 2004 and 14.5 % in 2005 to less than 5.0 % after 2006. In particular, there was a significant decline in major amputations of diabetic foot patient with Wagner 3 to 4 wounds. The frequency rate of major amputations in diabetic foot patient with Wagner 3 to 4 wounds fell from 35.7 % in 2004 to 4.4 % after 2007. The change in frequency of minor amputations was fluctuation. Conclusion: This study demonstrates that the introduction of a multidisciplinary team, coordinated by an endocrinologist and a podiatrist, for managing diabetic foot disease is associated with a reduction in the frequency of major amputations in patients with diabetes. [ABSTRACT FROM AUTHOR]

The aim of the research is to find out how much the diabetes patients know about the diabetes foot syndrome. As many as 85% of the examined think they get enough advice about their disease while 7% give a negative answer. 60% of the examined go to see the doctor and control their glycemia 12 times a year. The written instructions about the disease are obtained by 75%.The diabetes patients' involvement in the treatment of their disease, the degree of their knowledge and their harmful habits, as well as the quality of the attitudes to health and behavior - these are all standards for measuring the health protection achievement. To make the diabetes patients able to take an active part in treating their disease is the basic goal of the medical-educational work

Diabetes foot ulceration (DFU) has a negative impact on the quality of life and leads to disabling morbidity, such as lower extremity amputation (LEA). This study aimed to evaluate the LEA trend before and after the establishment of the diabetes foot team, an on-time debridement, on-site screening, and multidisciplinary integration with standardizing care, in Chang Gung Memorial Hospital, Chia Yi, Taiwan, starting in 2010. The study retrospectively investigated the non-traumatic LEA rate in diabetes foot (identified by using ICD-9-Clinical Modification (CM) codes, 250.70–250.83) and whole patients with diabetes (ICD-9 250.XX) yearly from 2004 to 2013. Patients were enrolled from hospitalization, emergency room (ER), or outpatient departments, respectively. Despite the overall incidence of diabetes foot in patients with diabetes remaining constant, from 3.47% in 2004 to 3.58% in 2013, the incidence of hospitalized diabetes foot from diabetes reduced, from 2.83% in 2004 to 1.51% in 2013. Introduction of integrated wound care also led to a reduction of the average LEA rate in hospitalized patients, from 15.27% (2004–2009) to 6.08% (2010–2013) ( P < 0.001). A similar decline of the LEA rate was observed for patients from hospitalization, ER and outpatient departments together with an average LEA rate from 7.99% (2004–2009) down to 3.02% (2010–2013) ( P < 0.001). In trend analysis, the curve estimation revealed a quadratic trend in the relationship between LEA rate and time ( R -square = 0.869, P = 0.001) for hospitalized patients as well as a linear ( R -square = 0.819, P < 0.001) and quadratic ( R -square = 0.845, P = 0.001) trend in the relationship between LEA rate and time for hospitalization, ER, and outpatient departments together. The LEA rate for DM patients declined from 372.72/100,000 in 2004 to 61.74/100,000 in 2013. With establishment of an organizing, standardized wound care protocol and integrated multidisciplinary team, we demonstrated a significant decline in the LEA rate both in diabetes foot patients and all patients with diabetes. These improvements can be attributed to introducing an efficient pathway with on-time debridement and early intervention of diabetes foot ulcers. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is a global epidemic. Peripheral neuropathy and peripheral vascular disease are complications of diabetes mellitus and the primary causative factors for foot ulceration. Foot ulceration is the leading cause of hospitalization in people with diabetes mellitus. The burden of foot ulceration on health care systems and individual patients is immense. Despite conventional treatment, there persists a high incidence of amputation. A multidisciplinary approach is required to prevent ulcers. This review describes the etiology and risk factors for diabetic foot ulceration and a system for evaluating the diabetic foot. The assessment of neuropathy and the grading of foot ulcers are critically examined. This is important to allow for standardization in clinical trials. The management of diabetic foot syndrome is reviewed. The treatments to ensure vascular supply to the lower limb and control of infection as well as novel therapies, which are becoming available to treat nonhealing, "no-option" diabetic ulcers, are discussed. [ABSTRACT FROM AUTHOR]

Objectives. To quantify the dynamic behavior of the heel pad in type 2 diabetic patients and age-matched healthy individuals using mathematical modeling.Background. No single parameter can fully describe the heel-pad biomechanical properties during the loading–unloading process.Design. A descriptive study using pseudoelastic modeling was conducted to simulate the heel-pad stress–strain relationship in the loaded and unloaded states. Transmission electron microscope was used to examine six heel specimens taken from amputated legs in diabetic and non-diabetic patients.Methods. Energy dissipation ratio, loading curvature, and unloading curvature were calculated from the stress–strain curve-fits. Differences in ultrastructure between the heel pad of healthy subjects and those with diabetes were described.Results. The diabetic patients had a significantly higher mean energy dissipation ratio (mean 36.1% (SD, 8.7%) vs mean 27.9% (SD, 6.1%); P<0.001) and mean unloaded curvatures (mean 11.8 (SD, 5.1) vs mean 8.46 (SD, 2.6); P<0.001) than those of the control group. The collagen fibrils in diabetic heel samples were ruptured with unclear striation and uneven distribution.Conclusions. The curvature parameters may explain the poor rebound phenomenon resulting in the high impact energy in diabetic heel pads. Breakdown in collagen fibrils may be responsible for this observation.RelevanceThese findings can be integrated into the fabrication of orthotics that dissipate excessive heel impact energy and protect against injury. [Copyright &y& Elsevier]

To systematically review clinical practice guidelines (CPGs) on diabetes foot and assess the consistency of recommendations, quality of CPGs and to present an evidence-map for explicating research trends and gaps. We performed a literature search on PubMed, Embase, and Web of Science, guideline databases and websites of diabetes society to include the diabetic CPGs. The basic information, recommendations for the diabetic foot, methodological quality and reporting quality of diabetic CPGs were exacted by the Excel. Four researchers evaluated the methodological and reporting quality of diabetic foot CPGs by AGREE II instrument and RIGHT checklist. R3.5.1 software was used to create all bubble plots. A total of 22 diabetic CPGs were included, eight CPGs were from different professional diabetes societies. Recommendations on diabetic foot complications involve Diabetic foot ulcer (DFU), Charcot neuropathy (CN) and Osteomyelitis (OM). Eight DFU diagnostic systems presented in 22 CPGs. According to the recommendations of diabetic CPGs, the treatment of DFU can be summarized in four major items; six recommendations on CN diagnosis and six recommendations on treatment of CN were consistent among studies. However, there were inconsistencies in three OM diagnosis recommendations and four OM treatment recommendations. Some recommendations in CPGs were not very specific and clear, and hence they were not reliable for OM diagnosis and treatment. Once these inconsistencies are resolved, validated, accurate and effective diagnosis and treatment of diabetes foot will lead to reduced costs and adverse complications. The results of this review add to our knowledge and promote the development of trustworthy CPGs on diabetes. • Different organization's guidelines may give conflicting recommendations. • Different grading systems used in guidelines confuse and hinder communication between guideline developers. • Four recommendations for diabetic foot ulcer standard care were consistent. • Six recommendations on charcot neuropathy diagnosis and treatment were consistent. • There were inconsistencies in osteomyelitis diagnosis and treatment recommendations. [ABSTRACT FROM AUTHOR]

Background: Diabetes is one of the most challenging chronic health conditions in the current era. Diabetes-related foot problems need proper patient education, and social media could a play role to disseminate proper information., Method: A systematic search was performed on Facebook groups using the key words "diabetes foot care", "diabetes foot", "diabetes foot management" and "podiatric care". The search resulted in 57 groups and detailed activity information was collected from those groups. Usefulness of each relevant post was determined. Regression analysis was performed to explore the factors associated with the level of usefulness of diabetes foot care-related Facebook groups., Results: Our search resulted in a total of 16 eligible diabetes foot care-related Facebook groups with a total of 103 eligible posts. The average number of group members for the selected groups were 265.75 with an interquartile range of 3.5-107.75. Of the total 103 timeline posts, 45.6% posts were categorized as useful, while the remaining posts were not useful. Top mentioned diabetes foot care practice was "Checking feet daily". Multivariable logistic regression analysis showed that the level of usefulness of diabetes foot care-related Facebook groups were significantly associated with the type of posts and no association was found with presence of "likes" and presence of comment., Conclusion: Facebook being a widely used social networking system, patient welfare organizations, doctors, nurses and podiatrists could use this platform to provide support to educating diabetes patients and their caregivers by disseminating useful and authentic knowledge and information related to diabetes foot care., (Copyright © 2016 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.)

Background: Diabetic foot ulceration is receiving more attention because of its high amputation and mortality rate. It is essential to establish the frequency of amputations in people with diabetes after any change to the management of diabetic foot care. The present study aim to compare the frequency of lower-extremity amputations in patients with diabetes foot ulcer over a ten-year period., Methods: Six hundred forty eight patients with diabetes foot ulcer were retrospectively studied from 2004 to 2013. The clinical features, laboratory results and the lower-extremity amputations were recorded. Major amputation was defined as amputations above the ankle while minor amputation was amputations below the ankle in the present study., Results: Patients with diabetic foot ulcer were old (age 66.96 ± 11.96 years), with a long duration of diabetes (10.30 ± 6.94 years), high HbA1c (9.19 ± 2.62 %), SBP (144.05 ± 24.18 mmHg), DBP (79.53 ± 11.88 mmHg), LDL-C (2.71 ± 0.93 mmol/L) and had great frequency of neuropathy (62.7 %), retinopathy (45.0 %), nephropathy (39.5 %) and PAD (33.2 %). From 2004 to 2013, the frequency of all lower-extremity amputations is 12.0 % (5.2 % major amputation, 6.8 % minor amputation). The frequency of major amputations decreased from 9.5 % in 2004 and 14.5 % in 2005 to less than 5.0 % after 2006. In particular, there was a significant decline in major amputations of diabetic foot patient with Wagner 3 to 4 wounds. The frequency rate of major amputations in diabetic foot patient with Wagner 3 to 4 wounds fell from 35.7 % in 2004 to 4.4 % after 2007. The change in frequency of minor amputations was fluctuation., Conclusion: This study demonstrates that the introduction of a multidisciplinary team, coordinated by an endocrinologist and a podiatrist, for managing diabetic foot disease is associated with a reduction in the frequency of major amputations in patients with diabetes.