Prevention, assessment, diagnosis and management of diabetic foot based on clinical practice guidelines

Abstract

Aim:Diabetic foot complications are the main reason for hospitalization and amputation in people with diabetes and have a prevalence of up to 25%. Clinical practice guidelines are recommendations based on evidence with the aim of improving health care. The main aim of this study was to carry out a systematic review of the levels of the evaluation and treatment strategies that appear in the clinical practice guidelines focus on diabetic foot or diabetes with diabetic foot section. Another objective of this study was to perform an analysis of the levels of evidence in support of the recommendations made by the selected clinical practice guidelines.Methods:A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and a quality assessment by the Appraisal of Guidelines for Research and Evaluation (AGREE II) were performed. The databases checked were “NICE”, “Cinahl”, “Health Guide”, “RNAO”, “Sign”, “PubMed”, “Scopus” and “NCG”. The search terms included were “diabetic foot”, “guideline(s)”, “practice guideline(s)” and “diabetes.”Results:Twelve articles were selected after checked inclusion criteria and quality assessment. A summary and classification of the recommendations was completed.Conclusions:The heterogeneity of levels of evidence and grades of recommendation of the CPGs included regarding the management, approach and treatment of DF makes it difficult to interpret and assume them in clinical practice in order to select the most correct procedures. Despite this and according to the detailed study of the guidelines included in this work, it can be concluded that the highly recommendable interventions for DF management are debridement (very high level of evidence and strongly recommended), foot evaluation (moderate level of evidence and fairly recommended) and therapeutic footwear (moderate level of evidence and fairly recommended).

Videocapillaroscopy of the Oral Mucosa in Patients with Diabetic Foot: Possible Diagnostic Role of Microangiopathic Damage?

“…It can be classified in neuropathic foot, ischemic foot and neuro-ischemic foot. However, finding a purely ischemic foot, i.e., not associated with signs of neuropathy, is rare [ 9 , 10 , 17 , 18 , 19 , 20 ].…”

“…A recent study has shown profound histopathological alterations at the microcirculation level in patients with diabetic foot that could justify the genesis of lesions [ 21 ]. However, it is generally accepted that there is a close correlation between microcirculation anomalies and neuropathy in diabetic patients, demonstrated by the reduction in nerve conduction, vibratory sensitivity, and in the alteration of the sudomotor function [ 2 , 5 , 6 , 7 , 19 , 20 , 21 ].…”

“…The most frequent vascular hemodynamic alterations in these patients reside in arteriovenous shunt openings and in alterations in the vasomotor response [ 20 ].…”

Diabetic foot: Which one comes first, the ulcer or the contracture?

“…Diabetic foot may develop in some diabetic patients as a consequence of advanced disease. It is defined as a structural or functional alteration of the foot that may manifest as ulcers, osteomyelitis, or gangrene, as a result of the interaction of different factors induced by sustained hyperglycemia and previous traumatic causes[ 1 , 2 ]. Diabetes-related foot complications have been identified as the single most common cause of morbidity among diabetic patients[ 3 ].…”

Complication rate among people with diabetes at low risk of foot ulceration in Fife, UK: an analysis of routinely collected data

“…A cornerstone in the delivery of preventative foot care for people with diabetes is regular foot screening to identify those likely to develop foot ulcers, and thus those most likely to benefit from podiatry [3–5]. Recent reviews highlight inconsistent recommendations in different clinical guidelines, and a low level of evidence for approaches to foot screening [4,6], in particular the frequency of monitoring [7] and the lack of formal validation in predictive studies [8,9]. The optimal monitoring frequencies are based on clinical consensus, rather than being evidence‐based.…”