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Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale Study, a prospective cohort study

  • L Prompers
  • M Huijberts
  • Jan Apelqvist
  • E Jude
  • A Piaggesi
  • K Bakker
  • M Edmonds
  • P Holstein
  • A Jirkovska
  • D Mauricio
  • G R Tennvall
  • H Reike
  • M Spraul
  • L Uccioli
  • V Urbancic
  • K Van Acker
  • J Van Baal
  • F Van Merode
  • N Schaper
Publishing year: 2008
Language: English
Pages: 700-707
Publication/Series: Diabetic Medicine
Volume: 25
Issue: 6
Document type: Journal article
Publisher: Wiley-Blackwell

Abstract english

Aims To determine current management and to identify patient-related factors and barriers that influence management strategies in diabetic foot disease. Methods The Eurodiale Study is a prospective cohort study of 1232 consecutive individuals presenting with a new diabetic foot ulcer in 14 centres across Europe. We determined the use of management strategies: referral, use of offloading, vascular imaging and revascularization. Results Twenty-seven percent of the patients had been treated for > 3 months before referral to a foot clinic. This varied considerably between countries (6-55%). At study entry, 77% of the patients had no or inadequate offloading. During follow-up, casting was used in 35% (0-68%) of the plantar fore- or midfoot ulcers. Predictors of use of casting were male gender, large ulcer size and being employed. Vascular imaging was performed in 56% (14-86%) of patients with severe limb ischaemia; revascularization was performed in 43%. Predictors of use of vascular imaging were the presence of infection and ischaemic rest pain. Conclusion Treatment of many patients is not in line with current guidelines and there are large differences between countries and centres. Our data suggest that current guidelines are too general and that healthcare organizational barriers and personal beliefs result in underuse of recommended therapies. Action should be undertaken to overcome these barriers and to guarantee the delivery of optimal care for the many individuals with diabetic foot disease.


  • Endocrinology and Diabetes
  • infection
  • diabetic foot
  • PAD
  • deliver of care


  • Genomics, Diabetes and Endocrinology
  • ISSN: 1464-5491
E-mail: jan [dot] apelqvist [at] med [dot] lu [dot] se


Genomics, Diabetes and Endocrinology

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Lund University Diabetes Centre, CRC, SUS Malmö, Jan Waldenströms gata 35, House 91:12. SE-214 28 Malmö. Telephone: +46 40 39 10 00