The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: development of an evidence‐based global consensus

Abstract

Foot problems complicating diabetes are a source of major patient suffering and societal costs. Investing in evidence-based, internationally appropriate diabetic foot care guidance is likely among the most cost-effective forms of healthcare expenditure, provided it is goal-focused and properly implemented. The International Working Group on the Diabetic Foot (IWGDF) has been publishing and updating international Practical Guidelines since 1999. The 2015 updates are based on systematic reviews of the literature, and recommendations are formulated using the Grading of Recommendations Assessment Development and Evaluation system. As such, we changed the name from 'Practical Guidelines' to 'Guidance'. In this article we describe the development of the 2015 IWGDF Guidance documents on prevention and management of foot problems in diabetes. This Guidance consists of five documents, prepared by five working groups of international experts. These documents provide guidance related to foot complications in persons with diabetes on: prevention; footwear and offloading; peripheral artery disease; infections; and, wound healing interventions. Based on these five documents, the IWGDF Editorial Board produced a summary guidance for daily practice. The resultant of this process, after reviewed by the Editorial Board and by international IWGDF members of all documents, is an evidence-based global consensus on prevention and management of foot problems in diabetes. Plans are already under way to implement this Guidance. We believe that following the recommendations of the 2015 IWGDF Guidance will almost certainly result in improved management of foot problems in persons with diabetes and a subsequent worldwide reduction in the tragedies caused by these foot problems. Copyright

Assessment of the Podiatric Risk on Diabetics in Dakar Hospital Area: Cross-Sectional Study in Regard to 142 Patients

“…Therefore, it's necessary to prevent its occurrence by a systematic foot examination. This examination allows an assessment of the foot risk and the screening of early lesions [3].…”

Manual and documents of International Working Group on the Diabetic Foot 2015 for prevention and treatment of diabetic foot diseases: the achievement of argumentative consensus (Russian cut version)

“…Частота и тяжесть заболеваний стопы различают-ся в разных регионах мира, главным образом вслед-ствие различных социально-экономических условий, обеспеченности особыми типами обуви и стандар-тами осуществления специализированной помощи [1]. Язвенные поражения стопы являются наиболее частой проблемой и характеризуются заболеваемо-стью около 2-4 % в год в развитых странах и даже выше в развивающихся странах [2].…”

Triangle of Wound Assessment Made Easy: Revisited

“…Recent clinical studies have demonstrated that in the presence of a clinically infected ulcer, a positive PTB test is highly suggestive of osteomyelitis, but a negative test does not rule out the diagnosis; conversely, in the situation of an apparently uninfected foot wound, a positive PTB test is not specific for osteomyelitis, but this diagnosis is unlikely if the PTB test is negative. [19][20][21][22][23][24][25] This clinical sign is of great importance since early reports in 1995, Grayson et al 16 who explored the possibility of osteomyelitis in wounds by the use of a sterile blunt metal probe. They concluded that the PTB test had a positive predictive value of 89%.…”

“…31 Furthermore, recently the International Working Group on Diabetic Foot Management (IWGDF) has warned against the use of topical antimicrobial dressing with the goal of improving wound healing or preventing secondary infection. 20 They went even further by saying that "currently supporting data are too limited to recommend topical antimicrobial therapy". [20][21][22] The use of antimicrobial dressings for DFUs was recently assessed via a systemic review which concluded that current evidence base is too weak to suggest any specific antimicrobial dressing.…”

“…20 They went even further by saying that "currently supporting data are too limited to recommend topical antimicrobial therapy". [20][21][22] The use of antimicrobial dressings for DFUs was recently assessed via a systemic review which concluded that current evidence base is too weak to suggest any specific antimicrobial dressing. 23 The management of diabetic foot ulcers pose a challenge to attending clinicians and some advanced and expensive topical antimicrobials have been in use through the last few decades.…”