Anichini Roberto, Zecchini Franco, Cerretini Ivano, Meucci Giuseppe, Fusilli Daniela, Alviggi Lorenzo, Seghieri Giuseppe, De Bellis Alessandra
Division of Diabetes and Diabetes Foot Unit, General Hospital of Pistoia AUSL n.3, Pistoia, Italy.
Diabetes Res Clin Pract. 2007 Feb;75(2):153-8. doi: 10.1016/j.diabres.2006.05.014. Epub 2006 Jul 21.
The aim of this prospective study was to evaluate the efficacy of the implementation of the International Consensus on the Diabetic Foot (ICDF) in the area of Pistoia (Tuscany, Italy), in terms of percentage of population screened, reduction of hospitalization, and reduction of lower extremity amputations. The study was carried out over a 5-year period (1999-2003) in a district general hospital covering a clearly defined and relatively static population. The implementation of ICDF was performed at district health care level, in collaboration with general practitioners, and at the hospital with the establishment of a multidisciplinary care team. The database for this study was extracted from the DRG Tuscany database, and the diabetes foot lesion data source was taken from the Data Elaboration Centre of the Health Care District of Pistoia, cross-checked with the clinical records of the Diabetes Unit. In the period of the study, there was an increase in both the total number of diabetic foot lesions observed and the number of patients with diabetes referred for evaluation to the Diabetes Unit of Pistoia. Following implementation, the total number of hospitalizations for diabetic foot lesions and the duration of clinical stay were reduced. The total incidence of amputations per 100,000 inhabitants decreased from 10.7 in 1999, to 10.1 in 2000, 2.7 in 2001, 6.3 in 2002 and 6.24 in 2003. In particular, while the incidence of major amputations decreased over time, the relative number of minor amputations increased in the first years, stabilizing at a higher rate in later years. Finally, while before 1999 most people from the Pistoia area were referred to various hospitals in Tuscany for diabetic foot problems, during the implementation period almost all were referred to the Diabetic Unit of Pistoia. This study shows the advantages of prospective data collection, demonstrating that the implementation of the International Consensus on the Diabetic Foot can improve foot care in diabetes.
这项前瞻性研究的目的是评估在意大利托斯卡纳区皮斯托亚地区实施《糖尿病足国际共识》（ICDF）的效果，评估指标包括筛查人口的百分比、住院率的降低以及下肢截肢率的降低。该研究在一家地区综合医院进行，为期5年（1999 - 2003年），这家医院覆盖了一个明确界定且相对稳定的人群。ICDF的实施是在地区医疗保健层面与全科医生合作进行的，同时在医院成立了一个多学科护理团队。本研究的数据库取自托斯卡纳区疾病诊断相关分组（DRG）数据库，糖尿病足病变数据来源取自皮斯托亚医疗保健区的数据处理中心，并与皮斯托亚糖尿病科的临床记录进行了交叉核对。在研究期间，观察到的糖尿病足病变总数以及转诊至皮斯托亚糖尿病科进行评估的糖尿病患者数量均有所增加。实施ICDF后，糖尿病足病变的住院总数和临床住院时间均有所减少。每10万居民的截肢总发生率从1999年的10.7降至2000年的10.1、2001年的2.7、2002年的6.3和2003年的6.24。特别是，虽然大截肢的发生率随时间下降，但小截肢的相对数量在最初几年有所增加，在随后几年稳定在较高水平。最后，在1999年之前，皮斯托亚地区的大多数人因糖尿病足问题被转诊至托斯卡纳的各家医院，而在实施期间，几乎所有人都被转诊至皮斯托亚糖尿病科。这项研究显示了前瞻性数据收集的优势，表明实施《糖尿病足国际共识》可以改善糖尿病患者的足部护理。
