Emphasizing Multidisciplinary Teams And More Research On DFUs

David G. Armstrong DPM MD PhD

The increasing prevalence of diabetes demands more multidisciplinary care and more research into the topic of preventing diabetic foot ulcers (DFUs). In a recent review in Diabetic Foot and Ankle, my co-authors and I tackled this issue.1

As the review notes, the ideal management of the diabetic foot to minimize limb loss requires a robust system of multidisciplinary care. To that end, an array of providers must not simply manage DFUs but must also ensure appropriate screening, education and surveillance, targeting not only referred patients but those patients who are not yet receiving care. Establishing a multidisciplinary team can be a challenge in institutions in which healthcare systems are composed of individuals or groups that each have a selective area of focus and lack incentive (financial or otherwise) to organize and provide care across the full spectrum of disease.

I think the best way to streamline care to create a multidisciplinary team is to create environments for success. This starts in training at teaching hospitals between podiatric surgeons and vascular surgeons among other specialists.

The review also addresses the “yawning gap” between the impact of diabetes and funding for research. Of more than 22,000 diabetes-related research projects with federal funding between 2002 and 2011, the study finds only 33 were related to the care of DFUs. Furthermore, although diabetic foot complications may account for up to 30 percent of the excess medical costs of patients with diabetes, the cumulative funding for these projects accounted for only 0.17 percent of the total U.S. funding for diabetes-related research.

I think the more we talk about this problem of the need for more research and the more questions we ask about it, the better. We are dealing with a silent epidemic. Patients get silent wounds, they have silent "leg attacks," they get amputations silently and they die silently.

This is unconscionable. We can do better.


1. Barshes NR, Sigireddi M, Wrobel JS, et al. The system of care for the diabetic foot: objectives, outcomes and opportunities. Diabet Foot Ankle. 2013; epub Oct. 10.

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