There exists limited data demonstrating that glycemic control can improve healing of diabetic foot wounds. From March through December 2017, patients followed in the Foot Wound Clinic of a large urban safety net health system were concurrently seen by diabetes specialists to determine whether improving glycemic control via an integrated treatment approach impacted wound healing. This pilot study is the first to examine the effect of diabetes specialty co-management with podiatric care of diabetic foot wounds.
Sixty patients were included in the analysis of this pilot program and were followed for an average of 220 days. Patients were classified as having either improved glycemic control (IGC) or non-improved glycemic control (NIGC) defined as < 1% HbA1c change at study end. Cohort characteristics and outcomes are summarized in Table 1. All patients had aggressive diabetic foot care including wound debridement and appropriate antibiotic therapy as determined by their podiatrist.
Ulcers worsened in 47% of NIGC patients compared to 13% of IGC patients with IGC patients having an average HbA1c reduction of 2%. With both NIGC and IGC groups receiving similar wound management, 63% of NIGC patients had decreased ulcer volume compared to 87% of IGC patients, suggesting that improving glycemic control, in collaboration with diabetes specialist co-management, contributes to improved wound healing and a trend for decreased resource utilization.
Table 1. Cohort characteristics and study outcomes
| IGC | NIGC | p-value | |
| Total No. of patients | 30 | 30 | |
| Total No. of ulcers | 36 | 41 | |
| Median ulcer size (mm3) Baseline Study End | 170 0 | 100 40 | |
| Patients with improved ulcer healing, n (%) | 26 (87) | 19 (63) | 0.04 |
| HbA1c, mg/dL Baseline Study End | 10.6 8.2 | 10.2 11.1 | 0.47 <0.005 |
| Hypertension, n (%) Pre-existing Controlled at baseline Controlled at study end | 25 (83) 19 (63) 19 (63) | 24 (80) 16 (53) 21 (70) | |
| ED visits Total visits Average No. of visits per patient Foot related Diabetes related | 35 1.9 10 4 | 50 2.3 26 2 | 0.19 0.02 0.38 |
| Average number of podiatric appointments | 5 | 7 | 0.92 |
| No. of patients seen by Diabetes specialist Average No. of specialist visits per patient No. of patients seen in co-management visit No. seen in sporadic visit No visits | 25 2.3 25 0 5 | 24 2.8 16 8 6 | |
| Lost to follow-up with diabetes specialist, n (%) | 13 (43) | 15 (50) |
| IGC | NIGC | p-value | |
| Total No. of patients | 30 | 30 | |
| Total No. of ulcers | 36 | 41 | |
| Median ulcer size (mm3) Baseline Study End | 170 0 | 100 40 | |
| Patients with improved ulcer healing, n (%) | 26 (87) | 19 (63) | 0.04 |
| HbA1c, mg/dL Baseline Study End | 10.6 8.2 | 10.2 11.1 | 0.47 <0.005 |
| Hypertension, n (%) Pre-existing Controlled at baseline Controlled at study end | 25 (83) 19 (63) 19 (63) | 24 (80) 16 (53) 21 (70) | |
| ED visits Total visits Average No. of visits per patient Foot related Diabetes related | 35 1.9 10 4 | 50 2.3 26 2 | 0.19 0.02 0.38 |
| Average number of podiatric appointments | 5 | 7 | 0.92 |
| No. of patients seen by Diabetes specialist Average No. of specialist visits per patient No. of patients seen in co-management visit No. seen in sporadic visit No visits | 25 2.3 25 0 5 | 24 2.8 16 8 6 | |
| Lost to follow-up with diabetes specialist, n (%) | 13 (43) | 15 (50) |
J.N. McNulty: None. B.J. Lewis: None. J. La Fontaine: None. A. Rose: None. M. Gomez: None. L. Meneghini: Advisory Panel; Self; Novo Nordisk Inc., Sanofi US. Consultant; Self; Sanofi US, Novo Nordisk Inc.. Advisory Panel; Self; Intarcia Therapeutics, Inc.. Other Relationship; Self; American Diabetes Association. U. Gunasekaran: None. M.S. Ruiz: None.
