Affiliation:
1. Queensland University of Technology Brisbane QLD
2. Allied Health Research Collaborative, Metro North Hospital and Health Service Brisbane QLD
3. La Trobe University Melbourne VIC
4. Hall and Prior Health and Aged Care Group Perth WA
5. Grampians Rural Health Alliance Ballarat VIC
6. Menzies School of Research Charles Darwin University Darwin NT
7. Royal Adelaide Hospital Adelaide SA
8. University of Adelaide Adelaide SA
9. First Peoples Health Unit Griffith University Gold Coast QLD
10. Diabetes Victoria Melbourne VIC
11. Diabetes Feet Australia, Australian Diabetes Society Sydney NSW
12. University of Sydney Sydney NSW
13. Royal Prince Alfred Hospital Sydney NSW
Abstract
AbstractIntroductionDiabetes‐related foot disease (DFD) — foot ulcers, infection, ischaemia — is a leading cause of hospitalisation, disability, and health care costs in Australia. The previous 2011 Australian guideline for DFD was outdated. We developed new Australian evidence‐based guidelines for DFD by systematically adapting suitable international guidelines to the Australian context using the ADAPTE and GRADE approaches recommended by the NHMRC.Main recommendationsThis article summarises the most relevant of the 98 recommendations made across six new guidelines for the general medical audience, including:
prevention — screening, education, self‐care, footwear, and treatments to prevent DFD;
classification — classifications systems for ulcers, infection, ischaemia and auditing;
peripheral artery disease (PAD) — examinations and imaging for diagnosis, severity classification, and treatments;
infection — examinations, cultures, imaging and inflammatory markers for diagnosis, severity classification, and treatments;
offloading — pressure offloading treatments for different ulcer types and locations; and
wound healing — debridement, wound dressing selection principles and wound treatments for non‐healing ulcers.
Changes in management as a result of the guidelineFor people without DFD, key changes include using a new risk stratification system for screening, categorising risk and managing people at increased risk of DFD. For those categorised at increased risk of DFD, more specific self‐monitoring, footwear prescription, surgical treatments, and activity management practices to prevent DFD have been recommended. For people with DFD, key changes include using new ulcer, infection and PAD classification systems for assessing, documenting and communicating DFD severity. These systems also inform more specific PAD, infection, pressure offloading, and wound healing management recommendations to resolve DFD.