Podiatric Care and the Likelihood of Amputation or Hospitalization for People with Diabetes and Foot Ulcers

OBJECTIVE: Some patients with diabetes and foot ulcers eventually require amputation or hospitalization. This study examines whether patients with diabetes and foot ulcers who receive care from podiatrists have different likelihoods of amputation and hospitalization than those who do not receive care from podiatrists. METHODS: Privately insured adults with diabetes and foot ulcer were found in the MarketScan Research Databases. One year of continuous enrollment prior to the date of the first claim with evidence of foot ulcer (index) was required. Patients with evidence of foot ulcer or amputation prior to index were excluded, resulting in 35,721 patients aged 65+ (Medicare) and 28,796 patients aged <65 (non-Medicare). Patients were followed for up to 48 months following index. Patients with pre-index podiatrist visits were matched to patients with no podiatrist visits using propensity score (PS) matching within caliper, to control for differences in sociodemographic variables, plan type, and health status. Cox proportional hazard models estimated the hazard of amputation or hospitalization controlling for the same covariates in the PS match.

RESULTS: Care by podiatrists was associated with a lower hazard of amputation (hazard ratio [HR]=0.801, P<0.01) and hospitalization (HR=0.917, P<0.01) in the Medicare population. The results were consistent in the non-Medicare population (HR=0.765, P<0.01 for amputation; HR=0.852, P<0.01 for hospitalization). Sensitivity analysis revealed similar results for PS-matched cohorts without caliper and unmatched cohorts.

CONCLUSION: In a population of commercially insured adults with diabetes and foot ulcer, care by podiatrists appears to prevent or delay amputation and hospitalization.