Abstract
Disclosure: Z. Wee: None. B. Yuen: None. V. Kalpana: None. W. Png: None. J. Feng: None. S. Zainudin: None.
Introduction: Diabetic foot ulcers (DFUs) result in significant morbidity to people with diabetes and are costly for the healthcare system. Diabetic Rapid Evaluation and lower limb Amputation Management (DREAM) clinic was set up with the aim to provide early directed specialist care for DFU management, while the Diabetic Limb Salvage (DLS) service is a one-stop surgical and wound care service. Initial data has shown lower major amputations rates and exemplary DFU healing outcomes with this multi-disciplinary approach. We aim to evaluate the burden of DFUs in terms of clinical outcomes and cost analysis. Methods: This is a single centre cohort study. Data was collected between August 2018 and September 2023 for patients with DFU-related diagnoses. Of these, patients with a primary diagnosis of DFU were included. Subgroup analysis was conducted for patients seen in the DREAM clinic and/or DLS. Baseline demographics and outcome measures including length of stay, amputation rates, readmission rates, and other morbidity as well as cost for each related admission were collected. Descriptive statistics, Pearson correlation analysis for continuous variables, and chi-square tests for categorical variables were performed. Institutional ethics board approval was exempted for a clinical audit study. Results: 1721 patients were admitted with a primary diagnosis of DFU; 57.8% were males and mean age was 62.5 ± 16.8 years with a racial distribution of 61% Chinese, 17.7% Malays and 14.3% Indians. Median HbA1c was 8.0% (63.9mmoL/mL) and median UACR 3.68mg/mmoL. 54.5% had microalbuminuria. Mean number of podiatry consults per participant was 4.73 ± 11.8. There were 420 minor lower extremity amputations (LEA) and 178 major LEA; 3.6% (64 participants) deceased with 51.6% (33 participants) having peripheral vascular disease as cause of death. Mean admissions per participant was 2.34; with multiple admission for DFUs in 22.2% and readmission within 30-days for DFU related diagnosis in 10.6%. Mean length of inpatient stay was 15.1 ± 23.4 days. Mean gross amount per admission was SGD$8705.67 ± 14259.51 (USD$6444.22 ± $10555.35). Only 12.9% were assessed in DREAM clinic or by DLS. When compared with the overall study population, minor LEA rate was 34.2% for DREAM/DLS cohort versus 14.9% whilst major LEA rate was 7.2% versus 7.8% respectively, with only 1 death in the DREAM/DLS cohort. There was a statistically significant relationship between DREAM/DLS cohort and minor LEA (ꭓ2(6) = 56.35, p <.001) but not major LEA (ꭓ2(4) =6.47, p = .167). Conclusion: DFUs represent a significant burden to the patient in terms of clinical outcomes and costs to the healthcare system. Our findings underscore the importance of the multidisciplinary approach to DFU management as an essential component in the continued drive towards lowering LEA, hospitalization, and mortality rates.
Presentation: Saturday, July 12, 2025