Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update)

Abstract

Diabetic foot disease results in a major global burden for patients and the health care system. The International Working Group on the Diabetic Foot (IWGDF) has been producing evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. In 2019, all IWGDF Guidelines have been updated based on systematic reviews of the literature and formulation of recommendations by multidisciplinary experts from all over the world. In this document, the IWGDF Practical Guidelines, we describe the basic principles of prevention, classification, and treatment of diabetic foot disease, based on the six IWGDF Guideline chapters. We also describe the organizational levels to successfully prevent and treat diabetic foot disease according to these principles and provide addenda to assist with foot screening. The information in these practical guidelines is aimed at the global community of health care professionals who are involved in the care of persons with diabetes. Many studies around the world support our belief that implementing these prevention and management principles is associated with a decrease in the frequency of diabetes‐related lower extremity amputations. We hope that these updated practical guidelines continue to serve as reference document to aid health care providers in reducing the global burden of diabetic foot disease.

Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

“…64 Any revascularization procedure should therefore be part of a comprehensive care plan that addresses other important issues including: prompt treatment of concurrent infection, regular wound debridement, biomechanical off-loading, control of blood glucose, and treatment of co-morbidities. 64 In particular, patients with a foot infection are at high risk for limb loss and should be treated as a medical emergency. The 1-year major amputation rate for such patients has been reported to be as high as 44%, 65 and delay in treatment can lead to rapid tissue destruction and lifethreatening sepsis 66 In those patients in whom the risk-benefit ratio of revascularization is unclear, it should be taken into account that some severely ischaemic ulcers heal without revascularization-two observational studies demonstrated healing rates of around 50% (with or without minor amputations) in patients unsuitable (either because they were deemed too frail or where revascularization was not technically possible) for revascularization.…”

The future for diabetic foot ulcer prevention: A paradigm shift from stratified healthcare towards personalized medicine

“…This is markedly different from elaborate specialist interdisciplinary foot care teams and pathways available for those who do ulcerate. 15 A possible reason can be found in national guidelines. [16][17][18] Many guidelines provide predominantly recommendations on risk assessment in their chapter on ulcer prevention, with almost no actual treatment recommendations.…”

Definitions and criteria for diabetic foot disease

“…In this paper, we provide an update of all definitions and criteria for diabetic foot disease based on the systematic reviews of the literature that form the basis of the 2019 IWGDF Guidelines. [3][4][5][6][7][8][9] Where possible, we have retained the definitions from previous versions 1 to facilitate consistent comparison with older studies. We have only made changes when the evidence necessitated updates of older definitions.…”