OBJECTIVE: Diabetic foot (DF), especially DF ulcers (DFUs) are a relatively frequent and financially burdensome late-stage complication of diabetes. However, data on the costs of podiatric care in the Czech Republic are scarce. The aim of this prospective multicenter study was to determine the total costs associated with long-term podiatric care in selected foot clinics across the Czech Republic. RESEARCH DESIGN AND METHODS: A total of 119 patients with DFUs (mean age of 68 ± 11 years, diabetes duration of 19 ± 11 years, HbA1c level of 62 ± 14 mmol/mol, composite WIfI score of 3 ± 2, 33 % had new DFUs, 37 % previous amputations, and 50 % had peripheral artery disease (PAD)) from 10 podiatric foot clinics in the Czech Republic were enrolled in our financial analysis. Direct and indirect costs associated with podiatric care - diagnostic and treatment methods - including angiological, radiological, and microbiological examinations, blood sampling, prescribed materials for local therapy, antibiotics, surgical procedures, offloading devices, hospital services and additional expenses such as patient transportation, doctors' visits, home care assistance, and work incapacity - were monitored over a 6-month period using an electronic database. RESULTS: The average cost of podiatric care per patient over a 6-month period was €2,506 with median €1,320. The largest expenses were spent on therapeutic procedures (51.4 %). Costs for patients hospitalized during the study period were significantly higher than for outpatients (€7,923 vs. €1,304 on average; P < 0.001). Among hospitalized patients, the main costs were hospital services (32 %), therapeutic procedures (26 %), and antibiotic and local therapies (20 %). Among outpatients, therapeutic procedures accounted for 74 % of the total costs. Newly developed DFUs or PAD were not linked to significantly increased costs. The composite WIfI score, primarily the wound component, was the only parameter that significantly positively correlated with the total podiatric costs (r = 0.434; 95 % CI 0.279-0.559; P < 0.0001). Other patient characteristics such as age, diabetes duration, DFU duration, and HbA1c level did not show significant cost correlations. CONCLUSIONS: On average, podiatric care for patients with DFUs in the Czech Republic is 3 to 9 times more expensive than standard diabetes healthcare. The expenses for hospitalized patients are almost 6 times higher than for outpatients. The composite WIfI score was the most significant indicator of podiatric financial burden.

• Klíčová slova
• Costs, Diabetic foot, Diabetic foot ulcers, Economy, Epidemiology,
• MeSH
• diabetická noha * ekonomika   terapie   epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• náklady na zdravotní péči * MeSH
• osobní újma zaviněná nemocí * MeSH
• podiatrie * ekonomika   MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

UNLABELLED: Scoring for the risk of Diabetic foot syndrome (DFS) should be performed regularly in each patient with diabetes mellitus (DM). Patients at risk for DFS should be followed by diabetologists, those with moderate and severe risk for the development of DFS or those with DFS in remission should be already followed by podiatrists. The aim of our study was to determine the extent of DFS risk screening procedures, dispensary care of patients at risk for DFS and treatment of patients with newly developed DFS in diabetes clinics in the Czech Republic. METHODS: To find out the study data, we prepared in cooperation with the ČDS ČLS JEP Committee a questionnaire survey for outpatient diabetology specialists. RESULTS: The questionnaire was completed by 57% (76/135) of diabetologists. Most of them dispensary approximately 1000- 2000 patients with DM. Their feet are checked by 98.7% of diabetologists (1.6 ± 0.8 times a year on average). Screening for the risk of DFS (13024) is performing in less than 100 patients by 74.3% of diabetologists, in 100-200 patients by 14.9% and in more than 200 patients by 10.8% of diabetologists. 77% of respondents are able to examine neuropathy, the rest send their patients to neurologists, peripheral arterial disease is evaluated by only 47.3% of diabetologists (35.3% of them use some form of instrumental examination), others (48.6%) send patients to angiologists, 4.1% of diabetologists do not examine PAD at all). Based on the assessed findings, more than half of the respondents (50.7%) perform scoring for the risk of DFS, but 1/5 of outpatient diabetologists do not know how the scoring is performed. If colleagues find a patient at a risk for DFS, they usually follow him/her by themselves (64.4%), in 24.6% of cases they send the patient immediately to podiatry or surgery (11%). If a patient with a new DFS comes at diabetology clinic, 72.6% of diabetologists are able to prescribe off-loading, 60.3% antibiotics, 47.9% local therapy. Only 52.1% of diabetologists send a patient with a new DFS to outpatient foot clinic, 39.7% to surgery, the rest of them elsewhere. CONCLUSION: Based on the questionnaire survey results, the screening of DFS is currently severely undersized in outpatient diabetology clinics, it is sufficiently performed only by 11% of diabetologists. Only 16% of diabetologists perform some form of non-invasive diagnostic procedures detecting peripheral arterial disease, neuropathy examinations are more common. If a diabetologist meet a patient with newly developed DFS, he/she is able to prescribe off-loading or antibiotics, but only half of the diabetologists send the patient to outpatient foot clinic, probably due to a lack of them or their overload.

• Klíčová slova
• diabetic foot syndrome, podiatric care, podiatry, prevention, treatment,
• MeSH
• antibakteriální látky MeSH
• diabetická noha * diagnóza   terapie   MeSH
• lékaři * MeSH
• lidé MeSH
• onemocnění periferních arterií * MeSH
• podiatrie * MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antibakteriální látky MeSH

Podiatry is the science dealing with the diagnostics and treatment of the foot and ankle and associated tissues and structures by all appropriate methods and also with the local manifestation of the overall processes in this area. Diabetic foot disease is defined as infection, ulceration or destruction of tissues of the foot associated with neuropathy and/or peripheral artery disease in the lower extremity of people with diabetes according to the latest edition of the International Consensus. Successful treatment and prevention of diabetic foot syndrome depends on a holistic approach, in which it is seen as part of the multiple organ involvement. Teamwork of series of experts is therefore necessary. Internist with diabetes and podiatric education plays a key role in this team in particular, when control diabetes and in the prevention and treatment of co-morbidities, in the diagnosis of malnutrition and in the nutritional therapy and in the early diagnosis and effective treatment of infections. Last but not least, internist in collaboration with other professionals works when treatment of lower limb ischemia, suitable offloading of the ulcer and topical therapy and in the prevention of ulcers. Recurrent ulcerations are the major problem in podiatry and it can occur in up to 40% of patients in the first year after healing. Follow-up of patients with diabetic foot syndrome by experienced internist can help reduce the serious consequences, including amputation and cardiovascular mortality.Key words: diabetic foot - internal medicine - podiatry.

• MeSH
• diabetická noha terapie   MeSH
• lidé MeSH
• podiatrie * MeSH
• vnitřní lékařství * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH