Diabetologie: Heilige Familie, Rumst and Centre Santé des Fagnes, Chimay, Belgium.
Diabetes Metab Res Rev. 2014 Nov;30(8):635-45. doi: 10.1002/dmrr.2523.
The study aimed to assess the economic and quality of life burden of diabetic foot disorders and to identify disparities in the recommendations from guidelines and the current clinical practice across the EU5 (Spain, Italy, France, UK and Germany) countries. Literature search of electronic databases (MEDLINE®, Embase® and Cochrane Database of Systematic Reviews) was undertaken. English language studies investigating economic and resource burden, quality of life and management of diabetic foot disease in the EU5 countries were included. Additionally, websites were screened for guidelines and current management practices in diabetic foot complication in EU5. Diabetic foot complications accounted for a total annual cost of €509m in the UK and €430 per diabetic patient in Germany, during 2001. The cost of diabetic foot complications increased with disease severity, with hospitalizations (41%) and amputation (9%) incurring 50% of the cost. Medical devices (orthopaedic shoes, shoe lifts and walking aids) were the most frequently utilized resources. Patients with diabetic foot complications experienced worsened quality of life, especially in those undergoing amputations and with non-healed ulcers or recurrent ulcers. Although guidelines advocate the use of multidisciplinary foot care teams, the utilization of multidisciplinary foot care teams was suboptimal. We conclude that diabetic foot disorders demonstrated substantial economic burden and have detrimental effect on quality of life, with more impairment in physical domain. Implementation of the guidelines and set-up of multidisciplinary clinics for holistic management of the diabetic foot disorders varies across Europe and remains suboptimal. Hence, guidelines need to be reinforced to prevent diabetic foot complications and to achieve limb salvage if complications are unpreventable.
本研究旨在评估糖尿病足疾病的经济和生活质量负担，并确定欧盟 5 国（西班牙、意大利、法国、英国和德国）指南建议与当前临床实践之间的差异。对 MEDLINE®、Embase® 和 Cochrane 系统评价数据库进行了文献检索。纳入了研究欧盟 5 国糖尿病足疾病经济和资源负担、生活质量和管理的英语语言研究。此外，还对欧盟 5 国糖尿病足并发症的指南和当前管理实践进行了网站筛选。2001 年，英国糖尿病足并发症的年总成本为 5.09 亿欧元，德国每位糖尿病患者为 430 欧元。随着疾病严重程度的增加，糖尿病足并发症的成本也在增加，其中住院治疗（41%）和截肢（9%）的费用占总成本的 50%。医疗设备（矫形鞋、鞋托和助行器）是最常使用的资源。患有糖尿病足并发症的患者生活质量下降，尤其是接受截肢手术、溃疡未愈合或溃疡反复发作的患者。尽管指南提倡使用多学科足部护理团队，但多学科足部护理团队的利用率并不理想。我们得出结论，糖尿病足疾病的经济负担很大，对生活质量有不利影响，身体功能领域的损害更大。欧洲各地对指南的实施和多学科诊所的建立以实现糖尿病足疾病的整体管理存在差异，且仍不理想。因此，需要加强指南以预防糖尿病足并发症，并在并发症无法预防时实现肢体保留。
