Australian guideline on prevention of foot ulceration: part of the 2021 Australian evidence‐based guidelines for diabetes‐related foot disease

Abstract

Background There are no current Australian guidelines on the prevention of diabetes-related foot ulceration (DFU). A national expert panel aimed to systematically identify and adapt suitable international guidelines to the Australian context to create new Australian evidence-based guidelines on prevention of first-ever and/or recurrent DFU. These guidelines will include for the first-time considerations for rural and remote, and Aboriginal and Torres Strait Islander peoples. Methods The National Health and Medical Research Council procedures were followed to adapt suitable international guidelines on DFU prevention to the Australian health context. This included a search of public databases after which the International Working Group on the Diabetic Foot (IWGDF) prevention guideline was deemed the most appropriate for adaptation. The 16 IWGDF prevention recommendations were assessed using the ADAPTE and GRADE systems to decide if they should be adopted, adapted or excluded for the new Australian guideline. The quality of evidence and strength of recommendation ratings were re-evaluated with reference to the Australian context. This guideline underwent public consultation, further revision, and approval by national peak bodies. Results Of the 16 original IWGDF prevention recommendations, nine were adopted, six were adapted and one was excluded. It is recommended that all people at increased risk of DFU are assessed at intervals corresponding to the IWGDF risk ratings. For those at increased risk, structured education about appropriate foot protection, inspection, footwear, weight-bearing activities, and foot self-care is recommended. Prescription of orthotic interventions and/or medical grade footwear, providing integrated foot care, and self-monitoring of foot skin temperatures (contingent on validated, user-friendly and affordable systems becoming available in Australia) may also assist in preventing DFU. If the above recommended non-surgical treatment fails, the use of various surgical interventions for the prevention of DFU can be considered. Conclusions This new Australian evidence-based guideline on prevention of DFU, endorsed by 10 national peak bodies, provides specific recommendations for relevant health professionals and consumers in the Australian context to prevent DFU. Following these recommendations should achieve better DFU prevention outcomes in Australia.

Adherence and Wearing Time of Prescribed Footwear among People at Risk of Diabetes-Related Foot Ulcers: Which Measure to Use?

“…Of people with diabetes, 19–34% develop a diabetes-related foot ulcer during their life time [ 1 ]. International [ 2 ] and national evidence-based guidelines [ 3 , 4 , 5 ] recommend the use of therapeutic footwear to reduce this risk. However, several studies have reported that patients’ adherence to wearing therapeutic footwear is often low, with patients wearing the footwear for approximately 50% of waking day time [ 6 , 7 ] or 70% of daily number of steps [ 8 ], which may contribute to the high recurrence rate of foot ulcers [ 1 , 9 , 10 ].…”

Australian evidence‐based guidelines for the prevention and management of diabetes‐related foot disease: a guideline summary

“…Here we summarise the key recommendations considered most relevant for the general medical audience, with a focus on prevention and classification. [16][17][18][19][20][21]45 In doing so, we highlight that many PAD, infection, offloading and wound healing management recommendations that are considered most relevant for specialist medical audiences have been omitted. [16][17][18][19][20][21] Thus, we strongly suggest people with DFD are referred to Examine all patients annually for PAD by taking a relevant history and palpating foot pulses.…”

“…For LOPS, this can be performed using a 10 g Semmes-Weinstein monofilament or Ipswich Touch Test; and for PAD, by taking a relevant history and palpating foot pulses. 16,18 People identified to not have LOPS or PAD can be categorised at very low risk of DFU and rescreened in 12 months. Individuals identified to have LOPS or PAD should be further examined according to the IWGDF risk stratification system for foot deformities, abundant callus, pre-ulcerative lesions, DFU history, amputation history, end-stage renal disease, and DFU (Box 7).…”

“…Further, treatment is recommended for any pre-ulcerative lesions, callus, ingrown toenails and fungal infections, and prescription of orthotic interventions considered to reduce abundant callus. 16 For people at moderate or high risk, prescribing medical-grade footwear and instructing patients to self-monitor foot skin temperatures daily to detect signs of pre-ulcerative lesions (when Weak Low GRADE = Grading of Recommendations, Assessment, Development and Evaluation. * The GRADE strength of recommendation rating is defined as the extent the panel is confident that the desirable effects (ie, benefits, such as improved health outcome) of an intervention/recommendation considerably outweigh the undesirable effects (ie, harms, such as adverse events) based on the available evidence.…”

Determinants of Adherence to Treatment in Type 2 Diabetic Patients: A Directed Qualitative Content Analysis Based on Pender’s Health Promotion Model

“…T2D is associated with a significant morbidity and mortality (Sun et al, 2022). The behaviors recommended in the guidelines for T2D patients include the adoption of a healthy lifestyle, that is, improving dietary patterns, increasing physical activity (PA), and taking diabetes medication (Hallberg et al, 2019; Kaminski et al, 2022). Following these recommendations helps patients improve their quality of life (Majeed et al, 2021).…”