The Diabetic Foot Valley Tuscany
The Diabetic Foot Valley Tuscany, led by Prof. Dr. Alberto Piaggesi, aims to establish a model of referral for Diabetic Foot (DF) care worldwide by creating a community of DF care in Tuscany, Italy.
The Members
Prof. Dr. Alberto Piaggesi (Lead)
Strategy
The base strategy applied on various levels of patient care is to improve patient outcome by:
- Implementing the International Guidelines for DF Management into real practice
- Implementing the already existing Tuscany Organizational Guideline on DF
- Establishing a Regional Network for DF involving all the professionals involved in the management of DF, both in the hospitals and in the community
- Homogenizing the approach to the cases by sharing diagnosis, treatments and management in a three-level model of care
- Collecting data in relation with the pathology, both on clinical, organizational and economic aspects, to improve knowledge and evidence on DF
- Promoting the quality in the management of DF by organizing courses, workshops, audits, scientific meetings inside the community of care in Diabetic Foot Valley Tuscany
Objectives
For the years 2023 – 2026 Diabetic Foot Valley Tuscany has the following objectives:
- Establish an integrated network of centres on three levels according to the severity of the pathology, with three centres of referral, twelve intermediate-level centres and a diffuse network of HCP in the community
- Build a regional electronic database and operational instruments that may serve both for management and research purposes
- Carry on amelioration projects to improve and set the standards to a number of crucial aspects in the management of the DF
- Produce data on the actual implementation of the DF care in Tuscany as result of Diabetic Foot Valley by measuring the effects of the amelioration projects
- Measure the impact of Diabetic Foot Valley Tuscany on the outcomes – clinical, economic, organizational – for DF before and after the intervention
- Publish and exploit the results of the projects in papers and congresses, as the results of a collective work of the whole community
Figure 1: Piaggesi A, et al. The Diabetic Foot Valley Project: bottom-up building of a community of practice for diabetic foot care in Tuscany. Journal of Wound Management. 2024;25(1):31-35.
Background of the Diabetic Foot
- The Diabetic Foot Syndrome (DFS) is a complex multimorbid condition affecting 25% of diabetic patients worldwide. It represents a clinical emergency because of its increasing incidence, its severity and progressiveness, with a trend to recur that reaches the striking rate of 98% at ten years follow up.
- DFS is the first cause of non-traumatic lower extremity amputation (LEA) in the world, exposing patients to a risk which is 60 times higher when compared to general population
- DFS bears a mortality rate of 60% in five years, comparable to that of the most aggressive form of cancer.
- Because of the high prevalence, the complexity and the high morbidity and mortality profile, DFS has been frequently associate to cancer, and a paradigm shift in the management strategies and in the resource allocation to cope with it have been invoked by scientists and specialists.
- In Tuscany, a Region on the west coast of northern Italy where some 250.000 diabetic patients live, with an esteemed presence of 12.000 of them affected by DFS, the problem was recognised since the early nineties and many among the diabetological units in the region activated a service dedicated to the prevention and care of DFS.
- The long lasting experience and the diffusion of DF clinics on all the different areas of the Region – all public services of the RHS – make of Tuscany an unicum in the national context, and probably also at the international level, a sort of Diabetic Foot Valley, as the more famous Silicon Valley in California.
- The analogy is sustained by the high concentration of clinical expertise and by the scientific production that has been continuous and of high quality along the years, covering the more relevant and actual aspects of DFS and contributing in producing the evidence in the field and to the improvement in the knowledge of the complexity and severity of this pathology.
Expected outcomes
- A new regional database and operational software for the management of DFS patients in the public diabetologic network will be designed, implemented and financed by Tuscany Region as part of the National Plan for Resilience and Recovery (PNRR)
- Amelioration projects will focus on the criticalities that emerged in the focus groups and their outcomes will depend on the nature of the critical items and the nature of the projects; some of them have already been set and are related to the quality and quantity of interventional procedures, in terms of revascularisation and infection management, and they will be most likely monitored by indicators that reflect not only the final outcome (i.e. healing, amputation, death), but also by intermediate outcomes, like delay of referral, number of procedures per patient, recurrences, and complications.
Meeting of the Diabetic Foot Valley Tuscany members
Articles and Videos
Bridging the Gap between Theory and Practice in Integrated Care: The Case of the Diabetic Foot Pathway in Tuscany
This article explores how the Diabetic Foot Pathway in Tuscany effectively integrates theory and practice, offering insights into practical applications of guidelines in diabetic foot care.
The Diabetic Foot Valley Project: A Community Approach to Diabetic Foot Care in Tuscany
This publication highlights the collaborative efforts within the Diabetic Foot Valley Project, showcasing Tuscany’s model as an innovative community-driven approach to managing diabetic foot care.
The Diabetic Foot Valley Project: A Community Approach to Diabetic Foot Care in Tuscany
This blog post provides an overview of the Diabetic Foot Valley Project, detailing how Tuscany’s integrated community approach is transforming diabetic foot care and serving as a potential model for global implementation.
The Diabetic Foot Valley Project: A Model for Implementing Diabetic Foot Syndrome Management
This article from the Integrated Care Journal outlines the Diabetic Foot Valley Project as an effective model for diabetic foot syndrome management, emphasizing its structured approach to improving patient outcomes.
Industry supporters
The Diabetic Foot Valley Tuscany is kindly supported by the following companies:
