Physician expert in diabetes is the natural team leader for managing diabetic patients with foot complications. A position statement of the Italian Diabetic Foot Study Group

Abstract

Diabetic Foot Syndrome (DFS) is a complex disease to be managed by a Multi Disciplinary Team (MDT). Nevertheless, a Team Leader (TL) should be designated to collaborate with members of the MDT in a patient-orientated approach. A TL should know and manage diabetes, related complications and comorbidities. The TL should have deep knowledge of peripheral neuropathy and arterial disease and be able to diagnose and manage foot infections, including prompt surgical treatment when needed. In Italy, after the pioneering phase in which diabetologists began managing medical and surgical aspects of DFS to fill unmet needs, nowadays there is a network of Diabetic Foot (DF) clinics managed by diabetologists. Italy is one of the countries belonging to Organization for Economic Cooperation and Development (OECD) with the lowest amputation rate in diabetic patients. In addition to the special attention to the care of diabetes, the unique expertise of diabetologists involved in DF management may have been a contributing factor. They all share a “patient centered model” of care mainly related to their internal medicine background and have skills in podiatric surgery to manage the specific needs of DF patients with acute or chronic conditions in a timely manner. In Italy, specific training courses and university master programs have been developed in recent years, to prepare internists (diabetologists/endocrinologists) to become TL’s. This has allowed DF care to move from the initial pioneering phase to a more structured phase, with the creation of specific pathways and roles. KEY WORDS diabetes; diabetic foot; multidisciplinary Team; Team Leader