Diabetes-related foot disease is among the most serious and costly complications of diabetes, yet many of its worst outcomes are considered preventable. Lower-extremity amputation in particular is devastating for patients and, in a substantial share of cases, avoidable through timely, coordinated care. Over the past decade, research has converged on one organizing principle: people with diabetic foot ulcers fare better when treated by a multidisciplinary team than by clinicians working in isolation. This article reviews what recent peer-reviewed literature shows about how these teams work and why they reduce amputations.
The Clinical Burden of Diabetes-Related Foot Disease
The scale of the problem explains why coordinated care matters. A 2023 review in Diabetes Care by McDermott and colleagues summarized the contemporary epidemiology: the lifetime risk of a foot ulcer among people with diabetes is estimated at 19–34%, and ulcers recur in roughly 65% of patients within five years of healing. About one in five people with diabetes will eventually undergo a lower-extremity amputation. Most striking is the mortality data — five-year mortality after a diabetic foot ulcer is estimated at 50–70%, rivalling or exceeding many cancers. The review also noted that, after decades of decline, amputation rates have risen again in several regions, with disproportionate increases among younger adults and among racial and ethnic minority populations.
What a Multidisciplinary Foot Care Team Looks Like
A diabetic foot ulcer is essentially a chronic disease with acute flares. It can involve skin, soft tissue, bone, nerves, and arteries at once — so no single specialty can manage it alone. In a 2020 systematic review in the Journal of Vascular Surgery, Musuuza and colleagues examined 33 studies of multidisciplinary teams and identified recurring features of the effective ones.
First, teams combined medical and surgical disciplines — commonly podiatry, vascular surgery, endocrinology, infectious disease, wound-care nursing, and orthotics. Second, larger teams benefited from clear structure: a designated “captain” coordinating care, supported by core and ancillary members. Third, effective teams relied on defined referral pathways and care algorithms so that patients reached the right clinician quickly. Fourth, regardless of composition, successful teams consistently addressed four tasks: glycemic control, local wound management, vascular disease, and infection. This last point matters — outcomes appear to depend less on which exact specialists are present than on whether the full range of contributing problems is systematically addressed.
Evidence That Team-Based Care Reduces Amputations
The evidence linking team-based care to fewer amputations is consistent, though it comes largely from observational studies rather than randomized trials. In the Musuuza review, 94% of the included studies reported a reduction in major amputations after a multidisciplinary team was introduced.
A separate 2020 systematic review and meta-analysis by Albright and colleagues, published in Diabetes Research and Clinical Practice, quantified the effect. Exposure to a multidisciplinary care team was associated with a relative risk of major amputation of roughly 0.44 to 0.61 — corresponding to a reduction in major amputation rates on the order of 40–55%. The consistency of this effect across diverse health systems in Europe and North America lends it considerable weight.
It is worth noting what these studies cannot show. Because randomized trials of an entire model of care are difficult to conduct, the literature cannot establish causation with the certainty of a drug trial. What it does show is a reproducible association: when fragmented care is replaced by a coordinated team, fewer limbs are lost.
Prevention and the Organization of Care
Team-based care is not only about treating established ulcers — it is also central to prevention. The 2023 update of the International Working Group on the Diabetic Foot (IWGDF) guidelines, summarized by Schaper and colleagues and detailed in the prevention guideline by Bus and colleagues, frames prevention around five cornerstones: identifying the at-risk foot; regularly inspecting and examining it; educating patients, families, and clinicians; ensuring that appropriate footwear is worn; and treating risk factors for ulceration.
The guidelines also recommend stratifying every person with diabetes by risk. Someone with neither loss of protective sensation nor peripheral artery disease is screened annually, while a person with a previous ulcer or amputation falls into the highest-risk category and warrants foot examination every one to three months. The IWGDF emphasizes that people with a healed ulcer need lifelong prevention delivered by a trained team as part of integrated care — a healed ulcer represents remission, not cure.
Key Takeaways
Diabetes-related foot disease carries a burden, in amputations and in mortality, that is easy to underestimate. The recent literature is consistent on one point: coordinated, multidisciplinary care is associated with substantially fewer major amputations, with reductions commonly reported in the range of 40–55%. Effective teams share recognizable features — combined medical and surgical expertise, clear leadership, defined referral pathways, and systematic attention to glucose control, wounds, circulation, and infection. Paired with structured, risk-based prevention as outlined in the IWGDF guidelines, team-based care represents the current evidence-based standard for protecting the limbs and lives of people with diabetes.
References
- McDermott K, Fang M, Boulton AJM, Selvin E, Hicks CW. Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care. 2023;46(1):209–221.
- Musuuza J, Sutherland BL, Kurter S, Balasubramanian P, Bartels CM, Brennan MB. A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers. Journal of Vascular Surgery. 2020;71(4):1433–1446.
- Albright RH, Manohar NB, Murillo JF, et al. Effectiveness of multidisciplinary care teams in reducing major amputation rate in adults with diabetes: A systematic review & meta-analysis. Diabetes Research and Clinical Practice. 2020;161:107996.
- Bus SA, Sacco ICN, Monteiro-Soares M, et al. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes/Metabolism Research and Reviews. 2024;40(3):e3651.
- Schaper NC, van Netten JJ, Apelqvist J, et al. Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update). Diabetes/Metabolism Research and Reviews. 2024;40(3):e3657.
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