Results of Multidisciplinary Care Models for High-Risk Diabetic Foot and Amputation: A Systematic Review with Meta-Analysis

Abstract

Introduction: High-risk diabetic foot is a common cause of lower-limb amputation and premature mortality. Multidisciplinary care models have shown potential benefits, but pooled quantitative evidence on specific outcomes remains limited.

Objective: To determine the effectiveness of multidisciplinary care models compared with standard care on major amputation rates and other clinical outcomes in adults with high-risk diabetic foot.

Methods: A systematic review with meta-analysis registered in PROSPERO. Searches were conducted in PubMed, Scopus, Web of Science, Cochrane CENTRAL, CINAHL, Lilacs, and gray literature through April 2026. Cohort studies, case-control studies, and systematic reviews were included. ROBINS-I, Newcastle-Ottawa, and AMSTAR-2 were used to assess bias, and GRADE was used to assess certainty. A random-effects meta-analysis was performed using the R meta package.

Results: Fourteen studies involving 17,914 participants were included. Multidisciplinary models reduced the risk of major amputation (RR 0.52; 95% CI 0.41–0.66; I² 68%; moderate certainty) and all-cause mortality (RR 0.72; 95% CI 0.58–0.89; I² 41%; moderate certainty), and increased complete healing (RR 1.47; 95% CI 1.28–1.69; I² 32%; moderate certainty). The evidence regarding minor amputation, healing time, recurrence, hospital stay, and quality of life was of low or very low certainty.

Conclusions: Multidisciplinary care models reduce major amputation and mortality and improve complete healing in patients with high-risk diabetic foot. Randomized clinical trials and standardized definitions are needed to strengthen the certainty of the evidence.