Despite many improvements have been achieved, diabetic foot disease (DFD) remains a clinical, social, and economic burden. In the last years, DFD showed an evolution of its characteristics with an increase of the ischaemic/neuro-ischaemic foot in comparison to the pure neuropathic foot. Simultaneously, there was and increased incidence of concomitant cardiovascular co-morbidities, which influences the higher fragility of patients with DFS. Peripheral arterial disease (PAD) in subjects with diabetic foot seems to show a more aggressive pattern, being more distal and difficult to treat. Untreatable PAD remains the unmet need for clinicians and the main risk factor of major amputation in patients with diabetic foot ulcers. Authors aimed to describe the evolution of diabetic foot patients in the last two decades, describing also the current and future treatment which may improve outcomes in the next generations.
ArmstrongDGBoultonAJMBusSA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367-2375. doi:https://doi.org/10.1056/NEJMra1615439
3.
GBD 2017 Disease and injury incidence and prevalence collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet. 2018;392(10159):1789-1858.
4.
LazzariniPAPacellaREArmstrongDGVan NettenJJ. Diabetes-related lower-extremity complications are a leading cause of the global burden of disability. Diabet Med. 2018;35:1297-1299.
5.
ArmstrongDGSwerdlowMAArmstrongAAConteMSPadulaWVBusSA. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res. 2020;13(1):16.
6.
GiuratoLVainieriEMeloniM, et al.Limb salvage in patients with diabetes is not a temporary solution but a life-changing procedure. Diabetes Care. 2015;38(10):e156–e157. doi:https://doi.org/10.2337/dc15-0989
7.
LazzariniPARaspovicKMMeloniMvan NettenJJ. A new declaration for feet’s sake: halving the global diabetic foot disease burden from 2% to 1% with next generation care. Diabetes Metab Res Rev. 2023 Nov 24:e3747. doi:https://doi.org/10.1002/dmrr.3747
8.
ManuCAMustafaOGBatesM, et al.Transformation of the multidisciplinary diabetic foot clinic into a multidisciplinary diabetic foot day unit: results from a service evaluation. Int J Low Extrem Wounds. 2014;13(3):173-179. doi:https://doi.org/10.1177/1534734614545877.
9.
VasPRJEdmondsMKavarthapuV,et al.The diabetic foot attack: “’Tis too late to retreat!”. Int J Low Extrem Wounds. 2018;17(1):7-13. doi:https://doi.org/10.1177/1534734618755582
10.
HicksCWSelvarajahSMathioudakisN, et al.Trends and determinants of costs associated with the inpatient care of diabetic foot ulcers. J Vasc Surg. 2014 Nov; 60(5):1247-1254.e2. doi:https://doi.org/10.1016/j.jvs.2014.05.009
11.
MeloniMAndreadiARuotoloV, et al.Hospital readmission in patients with diabetic foot ulcers: prevalence, causes, and outcomes. Int J Low Extrem Wounds. 2023 Oct 17:15347346231207747. doi:https://doi.org/10.1177/15347346231207747
12.
PrompersLSchaperNApelqvistJ, et al.Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE study. Diabetologia. 2008;51(5):747-755. doi:https://doi.org/10.1007/s00125-008-0940-0
13.
ArmstrongDGCohenKCourricSBhararaMMarstonW. Diabetic foot ulcers and vascular insufficiency: our population has changed, but our methods have not. J Diabetes Sci Technol. 2011;5(6):1591-1595. doi:https://doi.org/10.1177/193229681100500636
14.
MeloniMIzzoVGiuratoLLázaro-MartínezJLUccioliL. Prevalence, clinical aspects and outcomes in a large cohort of persons with diabetic foot disease: comparison between neuropathic and ischemic ulcers. J Clin Med. 2020;9(6):1780. doi:https://doi.org/10.3390/jcm9061780
15.
JudeEBOyiboSOChalmersNBoultonAJ. Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome. Diabetes Care. 2001;24(8):1433-1437. doi:https://doi.org/10.2337/diacare.24.8.1433
16.
FagliaEClericiGClerissiJ, et al.When is a technically successful peripheral angioplasty effective in preventing above-the-ankle amputation in diabetic patients with critical limb ischaemia?Diabet Med. 2007;24(8):823-829. doi:https://doi.org/10.1111/j.1464-5491.2007.02167.x
17.
FerraresiRMauriGLosurdoF,et al.BAD transmission and SAD distribution: a new scenario for critical limb ischemia. J Cardiovasc Surg (Torino). 2018;59(5):655-664.
18.
MeloniMIzzoVGiuratoLGandiniRUccioliL. Below-the-ankle arterial disease severely impairs the outcomes of diabetic patients with ischemic foot ulcers. Diabetes Res Clin Pract. 2019;152:9-15. doi:https://doi.org/10.1016/j.diabres.2019.04.031
19.
MeloniMMorosettiDGiuratoL, et al.Foot revascularization avoids major amputation in persons with diabetes and ischaemic foot ulcers. J Clin Med. 2021;10(17):3977. doi:https://doi.org/10.3390/jcm10173977
20.
TsubakimotoYNakamaTKamoiDAndohHUrasawaK. Outcomes of pedal artery angioplasty are independent of the severity of inframalleolar disease: a subanalysis of the multicenter RENDEZVOUS registry. J Endovasc Ther. 2020;27(2):186-193. doi:https://doi.org/10.1177/1526602820901838
21.
ArmstrongDGLaveryLAHarklessLB. Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care. 1998;21(5):855-859. doi:https://doi.org/10.2337/diacare.21.5.855
22.
LazzariniPACrambSMGolledgeJMortonJIMaglianoDJVan NettenJJ. Global trends in the incidence of hospital admissions for diabetes-related foot disease and amputations: a review of national rates in the 21st century. Diabetologia. 2023;66(2):267-287.
23.
MoxeyPWGogalniceanuPHinchliffeRJ, et al.Lower extremity amputations – a review of global variability in incidence. Diabet Med. 2011;28(10):1144-1153.
24.
FagliaEClericiGClerissiJ, et al.Long-term prognosis of diabetic patients with critical limb ischemia: a population-based cohort study. Diabetes Care. 2009;32(5):822-827. doi:https://doi.org/10.2337/dc08-1223
25.
ScatenaAPetruzziPFerrariM, et al.Outcomes of three years of teamwork on critical limb ischemia in patients with diabetes and foot lesions. Int J Low Extrem Wounds. 2012;11(2):113-119. doi:https://doi.org/10.1177/1534734612448384
26.
IacopiECoppelliAGorettiC,et al.Effect of direct endovascular revascularization based on the angiosome model on risk of major amputations and life expectancy in type 2 diabetic patients with critical limb ischemia and foot ulceration. J Am Podiatr Med Assoc. 2021 1;111(4): Article 3. doi:https://doi.org/10.7547/18-130
27.
ManuCAFreedmanBRashidHWinkleyKEdmondsME. Peripheral arterial disease located in the feet of patients with diabetes and foot ulceration demands a new approach to the assessment of ischemia. Int J Low Extrem Wounds. 2022;21(4):397-404. doi:https://doi.org/10.1177/1534734620947979
28.
MarcoMValentinaIDanieleM,et al.Peripheral arterial disease in persons with diabetic foot ulceration: a current comprehensive overview. Curr Diabetes Rev. 2021;17(4):474-485.
29.
GandiniRUccioliLSpinelliA,et al.Alternative techniques for treatment of complex below-the knee arterial occlusions in diabetic patients with critical limb ischemia. Cardiovasc Intervent Radiol. 2013;36(1):75-83. doi:https://doi.org/10.1007/s00270-012-0344-x
30.
TroisiNAdamiDPiaggesiA,et al.Non-reversed bifurcated vein graft improves time to healing in ischemic patients undergoing lower limb distal bypass. Int Angiol. 2023;42(1):1-8. doi:https://doi.org/10.23736/S0392-9590.22.04952-5
31.
UcciAPeriniPFreyrieA, et al.Endovascular and surgical venous arterialization for no-option patients with chronic limb-threatening ischemia: a systematic review and meta-analysis. J Endovasc Ther. 2023 Nov 27:15266028231210220. doi:https://doi.org/10.1177/15266028231210220
32.
OrrapinSSiribumrungwongB. Successful revascularization, angiosome concept, and multivessel revascularization: effects on wound healing: an Asian perspective. Int J Low Extrem Wounds. 2023 Nov 6:15347346231212330. doi:https://doi.org/10.1177/15347346231212330
33.
FitridgeRChuterVMillsJ, et al.The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes and a foot ulcer. Diabetes Metab Res Rev. 2023 Sep 19:e3686. doi:https://doi.org/10.1002/dmrr.3686. Epub ahead of print.
34.
ForsytheROApelqvistJBoykoEJ, et al.Effectiveness of revascularisation of the ulcerated foot in patients with diabetes and peripheral artery disease: a systematic review. Diabetes Metab Res Rev. 2020;36(Suppl 1):e3279. doi:https://doi.org/10.1002/dmrr.3279
35.
MeloniMIzzoVDa RosV, et al.Characteristics and outcome for persons with diabetic foot ulcer and no-option critical limb ischemia. J Clin Med. 2020;9(11):3745. doi:https://doi.org/10.3390/jcm9113745
36.
DubskýMJirkovskáABemRNemcováAFejfarováVJudeEB. Cell therapy of critical limb ischemia in diabetic patients – state of art. Diabetes Res Clin Pract. 2017;126:263-271. doi:https://doi.org/10.1016/j.diabres.2017.02.028
37.
ScatenaAPetruzziPMaioliF, et al.Autologous peripheral blood mononuclear cells for limb salvage in diabetic foot patients with no-option critical limb ischemia. J Clin Med. 2021;10(10):2213. doi:https://doi.org/10.3390/jcm10102213
38.
MeloniMGiuratoLAndreadiA,et al.Peripheral blood mononuclear cells: a new frontier in the management of patients with diabetes and no-option critical limb ischaemia. J Clin Med. 2023;12(19):6123. doi:https://doi.org/10.3390/jcm12196123
39.
PanunziAMadottoFSangalliE, et al.Results of a prospective observational study of autologous peripheral blood mononuclear cell therapy for no-option critical limb-threatening ischemia and severe diabetic foot ulcers. Cardiovasc Diabetol. 2022;21(1):196. doi:https://doi.org/10.1186/s12933-022-01629-y
40.
DubskýMHusákováJBemR, et al.Comparison of the impact of autologous cell therapy and conservative standard treatment on tissue oxygen supply and course of the diabetic foot in patients with chronic limb-threatening ischemia: a randomized controlled trial. Front Endocrinol (Lausanne). 2022;13:888809. doi:https://doi.org/10.3389/fendo.2022.888809
41.
AnandSSCaronFEikelboomJW, et al.Major adverse limb events and mortality in patients with peripheral artery disease: the COMPASS trial. J Am Coll Cardiol. 2018;71(20):2306-2315. doi:https://doi.org/10.1016/j.jacc.2018.03.008
42.
BonacaMPBauersachsRMAnandSS, et al.Rivaroxaban in peripheral artery disease after revascularization. N Engl J Med. 2020;382(21):1994-2004. doi:https://doi.org/10.1056/NEJMoa2000052
