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Real-world treatment patterns and diagnosis of charcot foot in franco-belgian diabetic foot expert centers (The EPiChar Study)

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Abstract

Aim

To evaluate the real-life diagnosis and therapeutic means of Charcot Neuroosteoarthropathy (CN) in French-Belgian diabetic foot expert centers.

Methods

We collected clinical characteristics, results of exams and therapeutic pathways of consecutive adult patients with diabetic osteoarthropathy seen in consultation or hospitalization from January 1 to December 31, 2019 in 31 diabetic foot expert centers. The primary outcome was to describe the diagnostic and management methods for CN according to patient clinical characteristics, the clinical-radiological characteristics of acute and chronic CN and discharge means.

Results

467 patients were included: 364 with chronic CN and 103 in the acute phase. 101 patients had bilateral chronic CN. Most patients were male (73.4%), treated with insulin (73.3%), and with multicomplicated diabetes. In the acute phase, edema and increased foot temperature were present in 75% and 58.3% of cases, respectively. Diagnosis confirmation was usually by MRI and the mode of discharge was variable. In the chronic phase, orthopedic shoes were prescribed in 81.5% of cases.

Conclusions

This observational study highlights the diagnostic and therapeutic practices in 31 diabetic foot centers. Our results highlight that the use of MRI and the modalities of offloading, an essential treatment in the acute phase, need to be better standardized. Centers were highly encouraging about creating a patient registry.

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Data availability

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Sarah Kabani for editing the article, Pascale Fabbro-Perray for methodological help, Jean Philippe Lavigne for critical reading of the manuscript and Anne-Clarisse Simonet for reglementary assistance.

EPiChar study group: Florence Baudoux (CHRU Lille), Marie Martine Bonello Faraill (CHU Nice), Pierre Bonnin (CH Annecy-Genevois), Florence Bouilloud (Hôpital Foch, Suresnes), Miguel Bourgade (CH La Trinité), Marie Cazaubiel (CH Bron, Tourcoing), Vaneva Chinganmartino (CHU Pointe-à-Pitre), Sylvaine Clavel (CH Le Creusot), Enrique Da Costa Correia (CH Vichy), Fabrice Devemy (CH Lens), Maud François (CHU Reims), Sylvie Grandperretvauthier (CHU Besançon), Laurence Kessler (CHU Strasbourg), Amal Lemoine (CH Vienne), Jacques Martini (CHU Rangueil, Toulouse), Arnaud Monier (CH Chartres), Myriam Moret (HCL Louis Pradel, Bron), Marie Muller (CHU Michallon, Grenoble), Vincent Rigalleau (CHU Haut-Lévêque, Pessac), Geneviève Crouzeix (CHU Brest), Nathalie Vigier Simorre (CH Narbonne), Julien Vouillarmet (HCL Lyon Sud, Pierre Bénite).

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or notfor-profit sectors.

Author information

Authors and Affiliations

  1. Service des Maladies métaboliques et Endocriniennes, CHU Nîmes, Univ Montpellier, Nîmes, France

    Carole-Anne Julien

  2. Service de Diabétologie, AP-HP La Pitié Salpétrière, Paris, France

    Georges Ha Van

  3. Service de Diabétologie, AP-HP Hôtel Dieu, Paris, France

    Jocelyne M’Bemba

  4. Service Endocrinologie, AP-HP Kremlin Bicêtre, Kremlin Bicêtre, France

    Muriel Bourgeon

  5. Service de Diabétologie, CH Sud Francilien, Corbeil-Essonnes, France

    Dured Dardari

  6. Service de Diabétologie, CH Roubaix, Roubaix, France

    Marc Lepeut

  7. Centre du Pied, Ransart, Belgium

    Isabelle Dumont

  8. Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France

    Mohammed Zakarya Zemmache & Chris Serrand

  9. Service d’Endocrinologie, Diabétologie, Maladies Métaboliques, CHU Dijon, Dijon, France

    Benjamin Bouillet

  10. 10PhyMedExp, INSERM U1046, UMR 9214, Univ Montpellier, Service Des Maladies Métaboliques, CHU Montpellier, Montpellier, France

    Ariane Sultan

  11. VBIC, INSERM U1047, Univ Montpellier, Service Des Maladies Métaboliques Et Endocriniennes, CHU Nîmes, Clinique du Pied Gard Occitanie, Route de Carnon, 30240, Le Grau du Roi, France

    Sophie Schuldiner

Authors
  1. Carole-Anne Julien
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  2. Georges Ha Van
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  3. Jocelyne M’Bemba
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  7. Isabelle Dumont
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  8. Mohammed Zakarya Zemmache
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  11. Ariane Sultan
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  12. Sophie Schuldiner
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Consortia

EPiChar study group

  • Florence Baudoux
  • , Marie Martine Bonello Faraill
  • , Pierre Bonnin
  • , Florence Bouilloud
  • , Miguel Bourgade
  • , Marie Cazaubiel
  • , Vaneva Chingan-Martino
  • , Sylvaine Clavel
  • , Enrique Da Costa Correia
  • , Fabrice Devemy
  • , Maud François
  • , Sylvie Grandperret-Vauthier
  • , Laurence Kessler
  • , Amal Lemoine
  • , Jacques Martini
  • , Arnaud Monier
  • , Myriam Moret
  • , Marie Muller
  • , Vincent Rigalleau
  • , Geneviève Crouzeix
  • , Nathalie Vigier-Simorre
  •  & Julien Vouillarmet

Contributions

S.S., GHV and CAJ conceived the study. S.S. wrote the manuscript. ZZ and CS conducted the statistical analysis. S.S. and CAJ interpreted the data. AS, GHV, JPL reviewed the manuscript. CAJ provided the medical data of the patients. S.S. is the guarantor of this works and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Sophie Schuldiner.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Our work was performed according to the guidelines of good clinical practice and the Declaration of Helsinki. The study was approved by the ethical committee (CPP Est-III, #2018-A01721-54) and registered on clinicaltrials.gov (#NCT03744039).

Consent to participate

Written informed consent was obtained from all patients before participation.

Additional information

Managed by Massimo Porta.

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The EPiChar study group members are listed in acknowledgements section.

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Julien, CA., Ha Van, G., M’Bemba, J. et al. Real-world treatment patterns and diagnosis of charcot foot in franco-belgian diabetic foot expert centers (The EPiChar Study). Acta Diabetol 60, 1209–1218 (2023). https://doi.org/10.1007/s00592-023-02101-3

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