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.

Table 2 Characteristics, advantages, disadvantages, and usage of common antidiabetic drugs

Drug name	Advantages	Disadvantages	Usage	Applicable patients and considerations
Metformin	Significantly lowers HbA1c levels; aids in weight reduction; reduces cardiovascular event risks	May cause gastrointestinal discomfort (e.g., diarrhea, nausea); use with caution in patients with renal impairment due to the risk of lactic acidosis	Typically taken orally, recommended during or after meals to reduce gastrointestinal side effects	Preferred for overweight or obese patients with type 2 diabetes, especially those at high risk of cardiovascular disease
Sulfonylureas	Rapidly lower blood glucose levels; convenient, often once-daily dosing	Risk of hypoglycemia; may cause weight gain	Usually taken before meals, with the dosage adjusted based on blood glucose levels	Suitable for patients without a high risk of hypoglycemia; attention needed for weight management in obese patients
DPP-4 inhibitors	Reduce HbA1c levels with minimal risk of hypoglycemia; minimal impact on weight	Relatively weaker glucose-lowering effect; potential risk of pancreatitis	Taken orally, typically once daily	Suitable for patients struggling with weight management or at risk of hypoglycemia, particularly elderly patients and those with chronic kidney disease
GLP-1 receptor agonists	Promote weight loss and improve cardiovascular health; significantly lower HbA1c levels	Require injection, which may reduce patient compliance; may cause gastrointestinal discomfort (e.g., nausea, vomiting)	Administered subcutaneously, usually weekly or daily depending on the drug type	Ideal for obese patients needing weight management and those with type 2 diabetes and cardiovascular diseases
Insulin	Effectively controls hyperglycemia and suitable for all types of diabetes; flexible dosage adjustments	Risk of hypoglycemia and weight gain; requires patient education and regular blood glucose monitoring	Administered subcutaneously, with dosage adjustments based on blood glucose levels and dietary intake	Suitable for patients with severe conditions or inadequate control with other medications, especially those with type 1 diabetes or gestational diabetes

HbA1c: Hemoglobin A1c.