Quak GSW, Lin JHX, Liew H, Tan E, Tan D, Yeo LS, Lim JA, Chew T, Cho YT, Chan SWY, Chandrasekar S, Lo ZJ, et al.
The international journal of lower extremity wounds. Date of publication 2025 Sep 29;volume ():15347346251381091.
1. Int J Low Extrem Wounds. 2025 Sep 29:15347346251381091. doi:
10.1177/15347346251381091. Online ahead of print.
Diabetic Foot Screening: A Systematic Review of Global Guidelines and
Questionnaire-Based Tools.
Quak GSW(1), Lin JHX(2), Liew H(3), Tan E(4), Tan D(4), Yeo LS(4), Lim JA(5),
Chew T(6), Cho YT(7), Chan SWY(7), Chandrasekar S(7), Lo ZJ(7).
Author information:
(1)Lee Kong Chian School of Medicine, Nanyang Technological University,
Singapore, Singapore.
(2)Department of Endocrinology, Woodlands Health, Singapore, Singapore.
(3)Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore.
(4)National Healthcare Group Polyclinics, Singapore, Singapore.
(5)Department of Podiatry, Woodlands Health, Singapore, Singapore.
(6)Department of Podiatry, Tan Tock Seng Hospital, Singapore, Singapore.
(7)Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore,
Singapore.
Diabetic foot ulcers are a significant complication of diabetes mellitus,
contributing to high morbidity, prolonged hospitalisations, and increased
healthcare costs. Early detection through diabetic foot screening (DFS) and
preventive management strategies are therefore crucial in reducing the incidence
of diabetic foot ulcers and improving patient outcomes. Hence, this study aims
to review and summarise the current practices in DFS and risk stratification to
aid subsequent clinical management. A systematic search of PubMed and Embase was
conducted to identify articles relevant to DFS guidelines and
questionnaire-based screening tools. Of 1761 studies screened, 15 met the
inclusion criteria. While national and international guidelines provide
comprehensive protocols for DFS with similarities in screening components,
differences exist in risk stratification approaches, frequency of assessments,
and integration of questionnaire-based tools such as Q-DFD, Thai Q-DFD, DFSQ-UMA
and MNSI. Analysis of DFS guidelines identified three key components: neuropathy
assessment, vascular assessment, and visual inspection. The screening methods
include monofilament testing, vibration perception, and pedal pulse palpation
with additional tools such as ankle-brachial index being used in some of the
guidelines. These can be performed by various healthcare providers, including
general practitioners, diabetes nurses, and podiatrists, ensuring accessibility
across different healthcare settings. Risk stratification models classify
patients into low-, moderate-, or high-risk categories, guiding screening
frequency which varies from annual to quarterly assessments depending on risk
level. Effective DFS, based on standardised guidelines and risk stratification
models, is essential for preventing diabetic foot ulcers. The integration of DFS
into routine clinical practice, supported by tools such as validated
questionnaires, can significantly improve outcomes for diabetic patients.
DOI: 10.1177/15347346251381091
PMID: 41021788
