Optimizing risk management for post-amputation wound complications in diabetic patients: Focus on glycemic and immunosuppressive control

Table 1 Risk factors, interventions, and management strategies for postoperative complications in diabetic patients

Risk factor	Impact on outcomes	Recommended interventions	Specific implementation methods	Involved professionals	Ref.
High HbA1c levels	Increased risk of infection, delayed wound healing	Preoperative optimization of HbA1c levels, stricter glycemic control	Dietary intervention: Low-GI diet plan; exercise management: At least 150 minutes of aerobic exercise weekly; medication: Rational use of antidiabetic drugs or insulin; self-monitoring: Use of CGM systems	Endocrinologists, dietitians, exercise therapists, nursing staff	Doudkani et al[26], Shin et al[27], Xu et al[28], Uslu et al[29], Ou-yang et al[30]
Immunosuppressive therapy	Increased susceptibility to infections, slower healing	Customized wound care plans, careful monitoring of immunosuppressive therapy	Regular wound assessments; individualized anti-infection treatments; monitoring immunosuppressant levels	Transplant specialists, immunologists, wound care specialists	Coccolini et al[14], Rayman[20]
Preoperative malnutrition	Impaired immune response, reduced tissue regeneration	Preoperative nutritional support, tailored dietary plans	Oral nutritional supplements; high-protein, vitamin-rich dietary regimen; regular nutritional assessments	Dietitians, endocrinologists, nursing staff	Zhu et al[31]
Peripheral neuropathy	Increased risk of pressure ulcers, reduced sensation	Regular foot inspections, customized footwear, professional wound care	Use of protective footwear; skin inspection and care for feet; professional foot pressure distribution assessments	Podiatrists, wound care specialists	Armstrong et al[4], Boyko et al[17], Bobirca et al[18]
History of infections	Higher risk of recurrent infections	Strict infection control measures, prophylactic antibiotics	Preoperative use of prophylactic antibiotics; bacterial culture of infection sites; dynamic assessment of antibiotic efficacy	Infectious disease specialists, surgeons	Armstrong et al[4], Rayman[20]
Chronic kidney disease	Slower wound healing, increased risk of complications	Preoperative optimization of renal function, nephrology consultation	Preoperative renal function evaluation; blood pressure and electrolyte balance control; development of individualized dialysis plans	Nephrologists, endocrinologists	Boyko et al[17], Moriconi et al[32]
Insufficient knowledge of diabetes management	Large glycemic fluctuations, poor patient compliance	Provide diabetes education programs, enhance disease management skills	Organize educational sessions; emphasize the importance of glycemic control; establish long-term patient support groups	Diabetes educators, endocrinologists, psychologists	Aloudah et al[33], Yeo et al[34]

CGM: Continuous glucose monitoring; HbA1c: Hemoglobin A1c.