Effectiveness of multidisciplinary care teams in reducing major amputation rate in adults with diabetes: A systematic review & meta-analysis

Diabetes Res Clin Pract. 2020 Mar;161:107996. doi: 10.1016/j.diabres.2019.107996. Epub 2020 Jan 11.

Abstract

Aims: To determine the pooled effectiveness of multidiscipinary care teams (MCTs) in reducing major amputation rates in adults with diabetes.

Methods: A systematic review and meta-analysis was performed, searching databases MEDLINE, EMBASE, Google Scholar, Cochrane Library, and Clinicaltrials.gov thru October 2018. We included only before-after studies comparing amputation rates before and after the implementation of a MCT for the prevention of major amputation in adults with diabetes. Our primary outcome was relative risk of major amputation. Risk ratios and 95% confidence intervals were calculated using a fixed effects model.

Results: Twenty studies met the inclusion criteria. Nine studies were included in the meta-analysis, and eleven were included in a qualitative analysis. Exposure to a MCT resulted in a protective effect ranging from a RR of 0.44 [p-value < 0.00001 (95% CI 0.38, 0.51) I2 = 67%] to a RR of 0.61 [p-value < 0.0001, (95% CI 0.50, 0.75) I2 = 0%] after sensitivity analysis, and remained robust in qualitative analysis.

Conclusions: Healthcare systems can expect a 39-56% amputation rate reduction after implementing an MCT amputation prevention program. These findings may justify the use of additional resources needed for program implementation by helping healthcare systems predict the anticipated benefit these teams have on "possible limbs saved".

Funding: None.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Amputation / statistics & numerical data*
  • Diabetes Complications / epidemiology
  • Diabetes Complications / therapy
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / therapy*
  • Humans
  • Interdisciplinary Communication*
  • Odds Ratio
  • Patient Care Team* / organization & administration
  • Treatment Outcome