Chen P, Vilorio NC, Dhatariya K, Jeffcoate W, Lobmann R, McIntosh C, Piaggesi A, Steinberg J, Vas P, Viswanathan V, Wu S, Game F, et al.
Diabetes/metabolism research and reviews. Date of publication 2024 Mar 1;volume 40(3):e3644.
1. Diabetes Metab Res Rev. 2024 Mar;40(3):e3644. doi: 10.1002/dmrr.3644. Epub
2023 May 25.
Guidelines on interventions to enhance healing of foot ulcers in people with
diabetes (IWGDF 2023 update).
Chen P(1)(2), Vilorio NC(3), Dhatariya K(4)(5), Jeffcoate W(6), Lobmann R(7),
McIntosh C(8), Piaggesi A(9), Steinberg J(10), Vas P(11), Viswanathan V(12), Wu
S(13), Game F(14).
Author information:
(1)Joondalup Health Campus, Ramsay Healthcare Australia, Joondalup, Western
Australia, Australia.
(2)Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia.
(3)Department of Diabetology, Diabetic Foot Unit, Plaza de la Salud General
Hospital, Santo Domingo, Dominican Republic.
(4)Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS
Foundation Trust, Norwich, UK.
(5)Norwich Medical School, University of East Anglia, Norwich, UK.
(6)Retired Physician, Nottingham, UK.
(7)Clinic for Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart,
Stuttgart, Germany.
(8)Podiatric Medicine, School of Health Sciences, University of Galway, Galway,
Ireland.
(9)Diabetic Foot Section, Department of Medicine, University of Pisa, Pisa,
Italy.
(10)Georgetown University School of Medicine, Georgetown, Washington DC, USA.
(11)King's College Hospital NHS Foundation Trust, London, UK.
(12)MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Center,
Chennai, India.
(13)Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin
University of Medicine and Science, North Chicago, Illinois, USA.
(14)University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.
AIMS: Principles of wound management, including debridement, wound bed
preparation, and newer technologies involving alternation of wound physiology to
facilitate healing, are of utmost importance when attempting to heal a chronic
diabetes-related foot ulcer. However, the rising incidence and costs of
diabetes-related foot ulcer management necessitate that interventions to enhance
wound healing of chronic diabetes-related foot ulcers are supported by
high-quality evidence of efficacy and cost effectiveness when used in
conjunction with established aspects of gold-standard multidisciplinary care.
This is the 2023 International Working Group on the Diabetic Foot (IWGDF)
evidence-based guideline on wound healing interventions to promote healing of
foot ulcers in persons with diabetes. It serves as an update of the 2019 IWGDF
guideline.
MATERIALS AND METHODS: We followed the GRADE approach by devising clinical
questions and important outcomes in the Patient-Intervention-Control-Outcome
(PICO) format, undertaking a systematic review, developing summary of judgements
tables, and writing recommendations and rationale for each question. Each
recommendation is based on the evidence found in the systematic review and,
using the GRADE summary of judgement items, including desirable and undesirable
effects, certainty of evidence, patient values, resources required, cost
effectiveness, equity, feasibility, and acceptability, we formulated
recommendations that were agreed by the authors and reviewed by independent
experts and stakeholders.
RESULTS: From the results of the systematic review and evidence-to-decision
making process, we were able to make 29 separate recommendations. We made a
number of conditional supportive recommendations for the use of interventions to
improve healing of foot ulcers in people with diabetes. These include the use of
sucrose octasulfate dressings, the use of negative pressure wound therapies for
post-operative wounds, the use of placental-derived products, the use of the
autologous leucocyte/platelet/fibrin patch, the use of topical oxygen therapy,
and the use of hyperbaric oxygen. Although in all cases it was stressed that
these should be used where best standard of care was not able to heal the wound
alone and where resources were available for the interventions.
CONCLUSIONS: These wound healing recommendations should support improved
outcomes for people with diabetes and ulcers of the foot, and we hope that
widescale implementation will follow. However, although the certainty of much of
the evidence on which to base the recommendations is improving, it remains poor
overall. We encourage not more, but better quality trials including those with a
health economic analysis, into this area.
© 2023 The Authors. Diabetes/Metabolism Research and Reviews published by John
Wiley & Sons Ltd.
DOI: 10.1002/dmrr.3644
PMID: 37232034 [Indexed for MEDLINE]
