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A Mobile Health Service to Manage Diabetic Foot in Homeless Patients

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  • 1 School of Medicine and Psychology, Sapienza University; Department of Radiology, Vascular and Interventional Radiology Unit, Sant'Andrea Hospital, Rome, Italy.
  • | 2 School of Medicine and Psychology, Sapienza University; Radiation Oncology, Sant'Andrea Hospital, Rome, Italy.
  • | 3 Department of General Medicine, Sapienza University, Rome, Italy.
  • | 4 School of Nursing, University of Rome Tor Vergata, Rome, Italy.
  • | 5 Department of Public Health, University of Rome Tor Vergata, Rome, Italy.
  • | 6 Department of Dermatology, Istituto Dermopatico dell'Immacolata IRCCS, Rome, Italy.
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Background

Homeless people live in poverty, with limited access to public health services. They are likely to experience chronic medical conditions, such as diabetes mellitus; however, they do not always receive the necessary services to prevent complications. This study was designed to determine the effectiveness of a volunteer health service outreach to reduce disparity in diabetic foot care for homeless people.

Methods

The research was conducted on 21 patients with diabetic ulcers of 930 homeless people visited between 2008 and 2013. Each ulcer was treated with regular medication every week for a mean ± SD of 17.6 ± 12 months. The inclusion criteria were 1) homeless with a previous diagnosis of diabetes or a blood glucose level greater than 126 mg/dL at first check and 2) foot ulcer caused by diabetic vasculopathy or neuropathy. The efficacy of the interventions was assessed against the number of successfully cured diabetic feet based on a reduced initial Wagner classification score for each ulcer.

Results

Clinical improvement was observed in 18 patients (86%), whose pathologic condition was completely resolved after 3 years and, therefore, no longer needed medication. One patient died of septic shock and kidney failure, and two patients needed amputation owing to clinical worsening of ulcers (Wagner class 4 at the last visit).

Conclusions

Most homeless people who have diabetes and diabetic foot encounter many difficulties managing their disease, and a volunteer health-care unit could be a suitable option to bridge these gaps.

Corresponding author: Marco Matteoli, MD, Department of Radiology, School of Medicine and Psychology, Sapienza University–Rome; Vascular and Interventional Radiology Unit Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy. (E-mail: marcomatteoli@email.it)