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Doctors newspaper online, 13.08.2019
video consultations
Two new telemedicine concepts are designed to improve the care of patients with diabetic foot in the countryside. GPs can swap timely with experts about the therapy.
Regular foot control: Professional care for even small wounds is the A & O of DFS prevention.
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BERLIN. Every fourth diabetic patient has Diabetic Foot Syndrome (DFS) during his lifetime. If detected later, affected persons may only be left with the decision to amputation. In order to diagnose symptoms in good time and to initiate the correct therapy, the German Diabetes Association (DDG) recommends consulting with DFS experts – also via telemedicine. Through these video briefing sessions, attending physicians may seek a second opinion, possibly avoiding loss of limb or foot.
Often recognized too late
"Most of these foot injuries in diabetes are still recognized too late and insufficiently treated," emphasizes Professor Ralf Lobmann from the DDG Executive Board in a statement from the DDG. The number of minor and major amputations among diabetics in Germany is high and is around 40,000 patients a year, estimates the DDG. For the care of DFS patients, around 2.4 billion euros are needed annually.
A solution for the reduction of the large number of major amputations could be a telemedicine networking of primary care physicians with experts of the DDG working group Diabetic Foot, suggests the diabetologist from Klinikum Stuttgart.
"In order to improve the long-term prognosis of diabetes patients with diabetic foot lesions, cooperation with specialists is necessary," explains the head of the DDG working group DFS. And: "The chances of recovery increase when as little time passes between the appearance of first symptoms, the presentation to the doctor, the diagnosis and finally the treatment by a specialist," said Lobmann in the communication.
What does the new concept look like?
This is where a new DDG concept comes in: The Working Group on Diabetic Foot and the Federation of Internal Medicine (BDI) have jointly developed a telemedicine-based specialist consultation for the diabetic foot. It aims to identify high-risk patients in a timely manner, improve and shorten the healing process, and avoid amputations. "In addition, telemedicine bridges bridging times or distances and thus offers the opportunity to include affected patients as quickly as possible in a treatment network," said Lobmann in the communication. In this way, adequate outpatient therapy or rapid inpatient treatment would be ensured.
There are currently discussions with various payers, so that this concept can be put into practice as quickly as possible. "We hope that positive decisions will be made soon so that DFS patients benefit as quickly as possible," adds DDG Managing Director Barbara Bitzer.
Another telemedical second opinion project is currently taking place in Baden-Württemberg, where it is funded by the State Ministry for Social Affairs and Integration. "Using an evaluation system, the attending physician uploads the patient's data and an expert evaluates it within 36 hours. Above all, the expert should confirm the necessity of an amputation or point out an alternative, "explains Lobmann. "It also increases the decision-making security of the treating physician and the patient and their relatives." As Medical Director of the Medical Clinic 3, Department of Endocrinology, Diabetology and Geriatrics of the Stuttgart Hospital, Lobmann is responsible for this state project.
With telemedicine against undersupply?
"Telemedicine has great potential to compensate for the undersupply of diabetes patients in rural areas," said DDG President Professor Monika Kellerer in the communication. Here, telemedicine could bridge distances to a specialist and compensate for differences in care.
The top priority at DFS is prevention, emphasizes the DDG. In all people with diabetes feet and footwear must be examined regularly. Above all, a thorough training of the patients is necessary. To avoid bruises, tight shoes and stockings with stitching should be taboo. Athlete's foot disorders are to be treated appropriately. Toenails should be cut by a podiatrist. Important for prophylaxis: Clenched toes can be relieved by a transection of appropriate muscle tendons. (eb / ice )
The AG Diabetic Foot of the DDG on the Internet: https://ag-fuss-ddg.de
See also the comment:
Diabetic Foot Syndrome: Telemedicine Simplifies Obtaining the Second Opinion
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