Multidisciplinary Team Care for Diabetic Foot Disease: A Twenty Four Month Prospective Implementation Cohort

Dr. Rajib Kumar Majumdar, Ghanshyam Singh, Dr. Nitin Kumar

Diabetic Foot; Multidisciplinary Team; Amputation; Wound Healing; Peripheral Arterial Disease; Vascular Surgery; Podiatry

Diabetic foot disease accounts for a substantial fraction of lower-extremity amputations globally, with disproportionate impact in regions of high diabetes prevalence and limited specialist access. Multidisciplinary team (MDT) care models combining endocrinology, podiatry, vascular surgery, plastic surgery, infectious diseases, and structured wound care have been shown to reduce amputation rates in high-income settings. We undertook a prospective implementation study of an MDT diabetic foot clinic at a tertiary medical centre, enrolling 156 patients managed under the MDT pathway and a comparator group of 130 patients receiving standard care at affiliated centres. Over 24 months of follow-up, ulcer healing at 12 weeks was achieved in 64.7% of MDT-managed patients compared with 41.5% of standard-care patients. Major amputation (above-ankle) occurred in 9.0% of MDT patients compared with 23.1% of standard-care patients (adjusted HR 0.42, 95% CI 0.24-0.74). Wagner grade 4-5 at presentation, peripheral arterial disease, osteomyelitis, HbA1c ≥10%, delayed presentation, and ESRD were independent predictors of major amputation. The findings reinforce the case for structured MDT diabetic foot services, with particular value where peripheral arterial disease and advanced wounds are common.

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