A Critical Evaluation of Existing Diabetic Foot Screening Guidelines

Abstract

■ Abstract AIM:To evaluate critically the current guidelines for foot screening in patients with diabetes, and to examine their relevance in terms of advancement in clinical practice, improvement in technology, and change in socio-cultural structure. METHODS: A structured literature search was conducted in Pubmed/Medline, CINAHL, Cochrane Register of Controlled Trials, and Google between January 2011 and January 2015 using the keywords '(Diabetes) AND (Foot Screening) AND (Guidelines)'. RESULTS: Ten complete diabetes foot screening guidelines were identified and selected for analysis. Six of them included the full-process guidelines recommended by the International Diabetes Federation. Evaluation of the existing diabetes foot screening guidelines showed substantial variability in terms of different evidence-based methods and grading systems to achieve targets, making it difficult to compare the guidelines. In some of the guidelines, it is unclear how the authors have derived the recommendations, i.e. on which study results they are based, making it difficult for the users to understand them. CONCLUSIONS: Limitations of currently available guidelines and lack of evidence on which the guidelines are based are responsible for the current gaps between guidelines, standard clinical practice, and development of complications. For the development of standard recommendations and everyday clinical practice, it will be necessary to pay more attention to both the limitations of guidelines and the underlying evidence.

Duration of Type 2 Diabetes is a Predictor of Elevated Plantar Foot Pressure

“…ing the various screening criteria [20]. Foot pressure measuring is a case in point, with the potential to become a screening guideline since, at the moment, there is absolutely no reference to foot pressure assessment as a means of preventing foot ulceration [30].…”

“…Screening for diabetes involves the identification of asymptomatic individuals who are at high risk of developing the disease or its complications through appropriate screening tests [20]. Hence, the investigation of peak plantar pressure alterations in the non-symptomatic diabetic foot may be an important procedure for avoiding foot complications in high-risk individuals.…”

Agreement of clinical tests for the diagnosis of peripheral arterial disease

“…In 2011, Stephens et al reported that the general practice for detecting PAD was mainly focused on pulse palpation, physical examination, history taking and patient reporting symptoms of intermittent claudication, the same methods of assessment for PAD which were used back in 1996 [11]. Although there is vast knowledge with regards to PAD, there seems to be lack of knowledge and consensus regarding the best method of assessment of PAD in patients living with diabetes [12,13].…”

Preliminaries

“…A substantial number of guidelines and consensus documents have been released and regularly adjourned over the years, and study groups, and even scientific societies, have been created with DF as the subject of interest and focus for research [1][2][3] .…”