Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update)

Robert J. Hinchliffe*, Rachael O. Forsythe, Jan Apelqvist, Ed J. Boyko, Robert Fitridge, Joon Pio Hong, Konstantinos Katsanos, Joseph L. Mills, Sigrid Nikol, Jim Reekers, Maarit Venermo, Eugene Zierler, Nicolaas C. Schaper, International Working Group on the Diabetic Foot (IWGDF)

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

60 Citations (Web of Science)

Abstract

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the diagnosis, prognosis, and management of peripheral artery disease (PAD) in patients with foot ulcers and diabetes and updates the previous IWGDF Guideline. Up to 50% of patients with diabetes and foot ulceration have concurrent PAD, which confers a significantly elevated risk of adverse limb events and cardiovascular disease. We know that the diagnosis, prognosis, and treatment of these patients are markedly different to patients with diabetes who do not have PAD and yet there are few good quality studies addressing this important subset of patients. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to devise clinical questions and critically important outcomes in the patient-intervention-comparison-outcome (PICO) format, to conduct a systematic review of the medical-scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. We here present the updated 2019 guidelines on diagnosis, prognosis, and management of PAD in patients with a foot ulcer and diabetes, and we suggest some key future topics of particular research interest.

Original languageEnglish
Article numbere3276
Number of pages12
JournalDiabetes-metabolism Research and Reviews
Volume36
Issue numberS1
DOIs
Publication statusPublished - Mar 2020

Keywords

  • diabetic foot
  • diagnosis
  • foot ulcer
  • guidelines
  • peripheral artery disease
  • prognosis
  • surgery
  • vascular disease
  • PERIPHERAL ARTERIAL-DISEASE
  • TRANSCUTANEOUS OXYGEN-TENSION
  • PHYSICAL-EXAMINATION
  • VASCULAR-SURGERY
  • SEVERE ISCHEMIA
  • ULCERS
  • REVASCULARIZATION
  • MANAGEMENT
  • ANGIOPLASTY
  • SURVIVAL
  • PERIPHERAL ARTERY-DISEASE

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