Pie diabético: abordaje integral, gestión de calidad y dimensión humana en el contexto latinoamericano

Miguel Molano; Luis Rodríguez Prato; Freddy Contreras

Autores/as

Miguel Molano Hospital Universitario Dr. Manuel Núñez Tovar https://orcid.org/0009-0004-2361-5048
Luis Rodríguez Prato Hospital Universitario Dr. Victorino Santaella Ruiz https://orcid.org/0009-0008-6748-6099
Freddy Contreras Universidad Central de Venezuela. Facultad de Medicina https://orcid.org/0000-0003-3691-3461

Palabras clave:

Pie Diabético, Úlceras de Pie Diabético, Clasificación de San Elián, Gestión de Calidad, Prevención de Amputaciones, Enfermedad Vascular Periférica, Revisión Narrativa

Resumen

Contexto: El pie diabético se posiciona como una de las complicaciones crónicas más devastadoras de la diabetes mellitus, resultando en una significativa morbilidad y mortalidad, así como en una elevada carga económica para los sistemas de salud. Objetivo: Esta revisión narrativa analiza la evidencia científica actual sobre el manejo integral del pie diabético, con especial énfasis en el contexto de Latinoamérica y Venezuela. Metodología/Análisis: Se evaluaron sistemas de clasificación validados, estrategias de prevención basadas en la evidencia, abordajes multidisciplinarios, terapias emergentes y mecanismos de gestión de calidad. Resultados: Se destaca la importancia clínica de implementar herramientas de triaje pronóstico como el Sistema de Puntuación de Heridas de San Elián (SEWSS), sustentado en indicadores de calidad estandarizados e integrando la dimensión psicosocial en un manejo holístico. Conclusión: Los datos disponibles demuestran que un enfoque estructurado —mediante equipos multidisciplinarios especializados y protocolos basados en guías internacionales contextualizadas al entorno local— puede reducir la tasa de amputaciones hasta en un 50%.

Descargas

Los datos de descargas todavía no están disponibles.

Citas

1. International Diabetes Federation (IDF). IDF Diabetes Atlas (10th Ed.). Brussels, Belgium: IDF; 2024. International Diabetes Federation (IDF). IDF Diabetes Atlas (10th Ed.). Brussels, Belgium: IDF; 2024. https://idf.org/

2. Ogle GD, Wang F, Haynes A, et al. Global type 1 diabetes prevalence, incidence, and mortality estimates 2025: Results from the International diabetes Federation Atlas, 11th Edition, and the T1D Index Version 3.0. Diabetes Res Clin Pract. 2025;225:112277. doi:10.1016/j.diabres.2025.112277

3. World Health Organization (WHO). Global report on diabetes-Diabetes fact sheet. Genova: WHO; 2024. https://www.who.int/news-room/fact-sheets/detail/diabetes

4. International Working Group on the Diabetic Foot. International Consensus on the Diabetic Foot & Practical and Specific Guidelines on the Management and Prevention of the Diabetic Foot. Launched at the 6th International Symposium on the Diabetic Foot, May 2011.

5. Boulton AJM, Armstrong DG, Hardman MJ, Malone M, Embil JM, Attinger CE, et al. Diagnosis and Management of Diabetic Foot Infections. Arlington (VA): American Diabetes Association; 2020 Jan. PMID: 32105420. DOI: 10.2337/db2020-01

6. Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017;376(24):2367-2375. doi: 10.1056/NEJMra1615439. PMID: 28614678.

7. Zhang Y, Lazzarini PA, McPhail SM, van Netten JJ, Armstrong DG, Pacella RE. Global Disability Burdens of Diabetes-Related Lower-Extremity Complications in 1990 and 2016. Diabetes Care. 2020;43(5):964-974. doi:10.2337/dc19-1614

8. Prompers L, Huijberts M, Schaper N, et al. Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study. Diabetologia. 2008;51(10):1826-1834. doi:10.1007/s00125-008-1089-6

9. Armstrong DG, Tan TW, Boulton AJM, Bus SA. Diabetic Foot Ulcers: A Review. JAMA. 2023;330(1):62-75. doi:10.1001/jama.2023.10578

10. 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 Metab Res Rev. 2024;40(3):e3657. doi:10.1002/dmrr.3657

11. Monteiro-Soares M, Boyko EJ, Jeffcoate W, et al. Diabetic foot ulcer classifications: A critical review. Diabetes Metab Res Rev. 2020;36 Suppl 1:e3272. doi:10.1002/dmrr.3272

12. Meggitt B. Surgical management of the diabetic foot. Br J Hosp Med. 1976;16:227-332.

13. Lavery LA, Armstrong DG, Harkless LB. Classification of diabetic foot wounds. J Foot Ankle Surg. 1996;35(6):528-531. doi:10.1016/s1067-2516(96)80125-6

14. Ince P, Abbas ZG, Lutale JK, et al. Use of the SINBAD classification system and score in comparing outcome of foot ulcer management on three continents. Diabetes Care. 2008;31(5):964-967. doi:10.2337/dc07-2367

15. Martínez-De Jesús FR. A checklist system to score healing progress of diabetic foot ulcers. Int J Low Extrem Wounds. 2010;9(2):74-83. doi:10.1177/1534734610371594

16. Gallardo-Alburqueque LA, Quispe-Landeo Y, Chanamé-Marín A, et al. (External validation of the Meggitt-Wagner, Texas University, SINBAD, and Saint Elian classifications for predicting major amputation in patients with diabetes at a public hospital in Peru. PLOS ONE. 2026;21(1):e0327601. doi: 10.1371/journal.pone.0327601).

17. Mills JE, Conte MS, Armstrong DG, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia and foot Infection (WIfI). J Vasc Surg 2014; 59: 220-234. doi: 10.1016/j.jvs.2013.08.003

18. Carro GV, Saurral R, Carlucci E, Gette F, Llanos MLÁ, Amato PS. A Comparison Between Diabetic Foot Classifications WIfI, Saint Elian, and Texas: Description of Wounds and Clinical Outcomes. Int J Low Extrem Wounds. 2022;21(2):120-130. doi:10.1177/1534734620930171

19. Huang Y, Xie T, Cao Y, et al. Comparison of two classification systems in predicting the outcome of diabetic foot ulcers: the Wagner grade and the Saint Elian Wound score systems. Wound Repair Regen. 2015;23(3):379-385. doi:10.1111/wrr.12289

20. American Diabetes Association Professional Practice Committee for Diabetes Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes-2026. Diabetes Care. 2026;49(Supplement 1):S261-S276. doi:10.2337/dc26-S012

21. Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, Sosenko JM, Ziegler D. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017 Jan;40(1):136-154. doi: 10.2337/dc16-2042. PMID: 27999003; PMCID: PMC6977405.

22. Bus SA, Sacco ICN, Monteiro-Soares M, et al. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev. 2024;40(3):e3651. doi:10.1002/dmrr.3651

23. Dorresteijn JA, Kriegsman DM, Assendelft WJ, Valk GD. Patient education for preventing diabetic foot ulceration. Cochrane Database Syst Rev. 2014;2014(12):CD001488. Published 2014 Dec 16. doi:10.1002/14651858.CD001488.pub5

24. Bus SA, Armstrong DG, van Deursen RW, et al. IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes. Diabetes Metab Res Rev. 2016;32 Suppl 1:25-36. doi:10.1002/dmrr.2697

25. Sicco A. Bus, Jaap J. van Netten,Diekje R. Schouten andMarcel G. W. Dijkgraaf. Cost-Effectiveness of Pressure-Guided-Offloading-Improved Custom-Made Footwear for People with Diabetes at High Risk of Plantar Foot Ulceration. Diabetology 2026. 7(4),70; https://doi.org/10.3390/diabetology7040070

26. American Diabetes Association Professional Practice Committee. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S128-S145. doi:10.2337/dc25-S006

[27] U.S. Food and Drug Administration (FDA). FDA Orange Book. Silver Spring, MD: FDA; 2024;89: 76.

27. Gallagher KA, Mills JL, Armstrong DG, et al. Current Status and Principles for the Treatment and Prevention of Diabetic Foot Ulcers. Circulation. 2024;149(4):e232-e253.

28. Yousuff H, Bakhsh M, Khawaja H, et al. The impact of multidisciplinary teams on the management of diabetic foot disease. Int J Low Extrem Wounds. 2024;23(2):234-247.

29. Pérez-Fernández E, Gónzalez-Rodríguez L, López-Dóriga P, et al. Multidisciplinary approach to diabetic foot disease: "Toe and Flow" model. Endocrinol Diabetes Nutr. 2018;65(8):478-485.

30. Ein-Gal Y, Aharon-Hananel G, Sigawi T, et al. A National Quality Survey of in-Patient Diabetic Foot Care. J Diabetes Complications. 2025;39(9):109088.

31. Lipsky BA, Senneville É, Abbas ZG, et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2023). Diabetes Metab Res Rev. 2023;39(7):e3660.

32. Turkish Society of Clinical Microbiology. The Diabetic Foot Wounds and Infections: Turkish Consensus Report, 2024. Klimik Dergisi. 2024;37(2):156-168.

33. Bus SA, Armstrong DG, Gooday C, et al. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023). Diabetes Metab Res Rev. 2023;39(7):e3662.

34 Huang L, Li X, Luo Y, et al. Negative pressure wound therapy for diabetic foot ulcers. Int Wound J. 2024;21(3):e70012.

35 Sorg H, Tilkorn DJ, Hager S, et al. Skin wound healing: An update on the current knowledge and concepts. Eur Surg Res. 2023;64(2):123-138.

36 Lusendi D, Fava P, Costantino C, et al. Quality indicators for diabetic foot ulcer management: A Delphi consensus study. Int J Low Extrem Wounds. 2024;23(1):56-68.

37. Vaisman F, Urrutia S, López J, et al. Psychosocial impact of diabetic foot ulcers: Prevalence of depression and quality of life in Latin American patients. Wound Repair Regen. 2025;33(1):e145-153.

38. International Working Group on the Diabetic Foot (IWGDF). IWGDF Guidelines on the prevention and management of diabetic foot disease (2023). Available from: https://iwgdfguidelines.org/.

39. International Working Group on the Diabetic Foot (IWGDF). IWGDF Guidelines on the prevention and management of diabetic foot disease (2023). Available from: https://iwgdfguidelines.org/

40. Martínez-De Jesús FR, González-Medina MF, Martínez Mendiola FN, Jiménez Godínez R, Gutiérrez-Aguilar P. Clasificación de San Elián para el seguimiento de las úlceras de pie diabético y su relevancia terapéutica. Rev Latinoam Cir. 2012;2(1):31-7.