oa Management of Chronic Diabetic Foot Ulcers at Primary Care Level in Qatar :An Alternative Paradigm in Wound Healing

BACKGROUND AND AIMS: Chronic Diabetic footulcers (CDFU) are associated with increased morbidity, mortality especially indeveloping countries. This cohort study assess the efficacy (CDFU)management at primary care & identifypredictive criteria of failure. METHODS: We conducted a 5-year retrospective cohort study withprospective long-term follow-up of all patients with (CDFU) who presented to Umgwalinah Health Centre, Doha, Qatar. Average follow-up was 1 year. Failure of healing of (CDFU) was themain outcome measure.Independent predictor variables were selected by logisticregression analysis. RESULTS: A total of 126 patients with diabetes were managed forvarious foot lesions as follows. Five patients (4%) of 126 underwent immediate amputation. Primary care led approach was successful for 91(92.86%) of 98 neuropathic ulcers, 3(30%) of 10 neuro-ischemic ulcer, 2(66%) of 3 Charcot foot ulceration, 4(100%) of 4 patients with second degree burns & 6(100%) of 6 traumatic foot ulceration or (P<.001,chi2 for trend).Independent factors predictive of failure to heal were presence of osteomyelitis(odds ratio [OR] = 1.6, 95% confidence interval [CI], 1.0-1.3), increased Hemoglobin A1C level (OR = 1.002; 95% CI, 1.2-1.3), severe peripheral vascular disease(OR = 1.0, 95% CI,1.0-1.03),prior hospitalization for(CDFU) (OR = 1.4; 95%CI, 1.2-1.6) & gangrenous lesion(OR = 1.7; 95% CI,1.3-2.1). No side effects were reported and there was a high level of satisfaction (patients and staff). CONCLUSIONS: Primary care based management of (CDFU) is efficacious, safeand acceptable. These findings may lead to a substantial reduction in the costof (CDFU) in the third world. Future comparative studies utilizing randomized controlled trials must be conducted in order to accurately assess the efficacy of primary care in managing (CDFU).