Fitridge R, Chuter V, Mills J, Hinchliffe R, Azuma N, Behrendt CA, Boyko EJ, Conte MS, Humphries M, Kirksey L, McGinigle KC, Nikol S, Nordanstig J, Rowe V, Russell D, van den Berg JC, Venermo M, Schaper N, et al.
Diabetes/metabolism research and reviews. Date of publication 2023 Sep 19;volume ():e3686.
1. Diabetes Metab Res Rev. 2023 Sep 19:e3686. doi: 10.1002/dmrr.3686. Online
ahead of print.
The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in
people with diabetes and a foot ulcer.
Fitridge R(1), Chuter V(2), Mills J(3), Hinchliffe R(4), Azuma N(5), Behrendt
CA(6), Boyko EJ(7), Conte MS(8), Humphries M(9), Kirksey L(10), McGinigle
KC(11), Nikol S(12), Nordanstig J(13), Rowe V(14), Russell D(15), van den Berg
JC(16), Venermo M(17), Schaper N(18).
Author information:
(1)Faculty of Health and Medical Sciences, University of Adelaide and Vascular
and Endovascular Service, Royal Adelaide Hospital, Adelaide, South Australia,
Australia.
(2)School of Health Sciences, Western Sydney University, Campbelltown, New South
Wales, Australia.
(3)Baylor College of Medicine, Houston, Texas, USA.
(4)Bristol Centre for Surgical Research, University of Bristol, Bristol, UK.
(5)Asahikawa Medical University, Hokkaido, Japan.
(6)Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek,
Asklepios Medical School, Hamburg, Germany.
(7)University of Washington, Seattle, Washington, USA.
(8)San Francisco Medical Centre, University of California, San Francisco,
California, USA.
(9)UC Davis Medical Centre, Sacramento, California, USA.
(10)The Cleveland Clinic, Cleveland, Ohio, USA.
(11)University of North-Carolina, Chapel Hill, North Carolina, USA.
(12)Clinical and Interventional Angiology, Asklepios Klinik, St Georg, Hamburg,
Germany.
(13)Sahlgrenska University Hospital, Gothenburg, Sweden.
(14)David Geffen School of Medicine, UCLA, Los Angeles, California, USA.
(15)Leeds Teaching Hospitals NHS Trust, Leeds, UK.
(16)CENTRO VASCOLARE TICINO Ospedale Regionale di Lugano, sede Civico and
Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische
Radiologie Inselspital, Universitätsspital, Bern, Switzerland.
(17)Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
(18)Division of Endocrinology, Department Internal Medicine, MUMC+, Maastricht,
The Netherlands.
Diabetes related foot complications have become a major cause of morbidity and
are implicated in most major and minor amputations globally. Approximately 50%
of people with diabetes and a foot ulcer have peripheral artery disease (PAD)
and the presence of PAD significantly increases the risk of adverse limb and
cardiovascular events. The International Working Group on the Diabetic Foot
(IWGDF) has published evidence based guidelines on the management and prevention
of diabetes related foot complications since 1999. This guideline is an update
of the 2019 IWGDF guideline on the diagnosis, prognosis and management of
peripheral artery disease in people with diabetes mellitus and a foot ulcer. For
this guideline the IWGDF, the European Society for Vascular Surgery and the
Society for Vascular Surgery decided to collaborate to develop a consistent
suite of recommendations relevant to clinicians in all countries. This guideline
is based on three new systematic reviews. Using the Grading of Recommendations,
Assessment, Development, and Evaluation framework clinically relevant questions
were formulated, and the literature was systematically reviewed. After assessing
the certainty of the evidence, recommendations were formulated which were
weighed against the balance of benefits and harms, patient values, feasibility,
acceptability, equity, resources required, and when available, costs. Through
this process five recommendations were developed for diagnosing PAD in a person
with diabetes, with and without a foot ulcer or gangrene. Five recommendations
were developed for prognosis relating to estimating likelihood of healing and
amputation outcomes in a person with diabetes and a foot ulcer or gangrene.
Fifteen recommendations were developed related to PAD treatment encompassing
prioritisation of people for revascularisation, the choice of a procedure and
post-surgical care. In addition, the Writing Committee has highlighted key
research questions where current evidence is lacking. The Writing Committee
believes that following these recommendations will help healthcare professionals
to provide better care and will reduce the burden of diabetes related foot
complications.
© The Author(s). Published by Elsevier Inc. on behalf of The Society for
Vascular Surgery, Elsevier B.V on behalf of European Society for Vascular
Surgery and John Wiley & Sons Ltd.
DOI: 10.1002/dmrr.3686
PMID: 37726988
