Department of General Practice, University College Cork, Cork, Ireland.
BMJ Open. 2013 May 8;3(5):e002331. doi: 10.1136/bmjopen-2012-002331.
To determine the effect of contact with a podiatrist on the occurrence of Lower Extremity Amputation (LEA) in people with diabetes.
We conducted a systematic review of available literature on the effect of contact with a podiatrist on the risk of LEA in people with diabetes. Eligible studies, published in English, were identified through searches of PubMed, CINAHL, EMBASE and Cochrane databases. The key terms, 'podiatry', 'amputation' and 'diabetes', were searched as Medical Subject Heading terms. Reference lists of selected papers were hand-searched for additional articles. No date restrictions were imposed.
Published randomised and analytical observational studies of the effect of contact with a podiatrist on the risk of LEA in people with diabetes were included. Cross-sectional studies, review articles, chart reviews and case series were excluded. Two reviewers independently assessed titles, abstracts and full articles to identify eligible studies and extracted data related to the study design, characteristics of participants, interventions, outcomes, control for confounding factors and risk estimates.
Meta-analysis was performed separately for randomised and non-randomised studies. Relative risks (RRs) with 95% CIs were estimated with fixed and random effects models as appropriate.
Six studies met the inclusion criteria and five provided data included in meta-analysis. The identified studies were heterogenous in design and included people with diabetes at both low and high risk of amputation. Contact with a podiatrist did not significantly affect the RR of LEA in a meta-analysis of available data from randomised controlled trials (RCTs); (1.41, 95% CI 0.20 to 9.78, 2 RCTs) or from cohort studies; (0.73, 95% CI 0.39 to 1.33, 3 Cohort studies with four substudies in one cohort).
There are very limited data available on the effect of contact with a podiatrist on the risk of LEA in people with diabetes.
确定与足病医生接触对糖尿病患者下肢截肢（LEA）发生的影响。
我们对有关与足病医生接触对糖尿病患者LEA 风险影响的现有文献进行了系统评价。通过对 PubMed、CINAHL、EMBASE 和 Cochrane 数据库的搜索，确定了符合条件的以英文发表的研究。使用医学主题词搜索了“足病学”、“截肢”和“糖尿病”等关键词。对选定论文的参考文献进行了手工搜索，以查找其他文章。未对日期进行限制。
纳入了已发表的关于与足病医生接触对糖尿病患者LEA 风险影响的随机和分析性观察研究。排除了横断面研究、综述文章、图表回顾和病例系列。两名评审员独立评估标题、摘要和全文，以确定符合条件的研究，并提取与研究设计、参与者特征、干预措施、结局、混杂因素控制和风险估计相关的数据。
分别对随机和非随机研究进行了荟萃分析。适当情况下，使用固定效应模型和随机效应模型估计了相对风险（RR）及其 95%置信区间（CI）。
有 6 项研究符合纳入标准，其中 5 项提供了包含在荟萃分析中的数据。所确定的研究在设计上存在异质性，包括低截肢风险和高截肢风险的糖尿病患者。对来自随机对照试验（RCT）的现有数据进行荟萃分析（1.41，95%CI 0.20 至 9.78，2 项 RCT）或来自队列研究的荟萃分析（0.73，95%CI 0.39 至 1.33，3 项队列研究中有 4 项亚研究在一个队列中），并未显示与足病医生接触对 LEA 的 RR 有显著影响。
关于与足病医生接触对糖尿病患者 LEA 风险的影响，现有数据非常有限。
