2020IWGDF: 17 recommendations for diabetic foot diagnosis

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The global burden of diabetes has increased rapidly over the past decade.Since 1980, the number of patients with diabetes has tripled, and the severity of diabetes-related complications has received increasing attention. For example, diabetic foot is one of the main causes of non-traumatic amputations.Since 1999, the International Working Group on Diabetic Foot (IWGDF) has been developing evidence-based guidelines for the prevention and management of diabetic foot disease.At the beginning of 2020, the IWGDF updated the relevant content of diabetic foot diagnosis. The relevant content is organized as follows for your reference.1 Regardless of the presence or absence of foot ulcers in diabetic patients, they are screened annually for peripheral arterial disease (PAD), including related medical history collection and palpation of the dorsal foot artery.(GRADE evaluation system: strong; quality of evidence: low) Compared with patients without diabetes, PAD characteristics of patients with diabetes are as follows: 1) more common, 2) also affect young individuals, 3) often bilateral or moreLesions of the branch, 4) distal involvement, 5) higher degree of intravascular calcification, 6) faster progress and higher risk of amputation.2 According to the related medical history and palpation of the dorsal foot artery, all patients with diabetes and patients with foot ulcers will be examined clinically to determine the presence of PAD.(Strong; Low) 3 For most diabetic patients with foot ulcers, PAD cannot be completely ruled out by clinical examination. Doppler arterial waveform examination is required to measure bilateral ankle systolic blood pressure and bilateral ankle brachial index (ABI).Or measure toe systolic blood pressure and toe brachial index (TBI).There is no single way that proves to be optimal, and there is no established threshold that can be used to reliably exclude PAD.However, most PADs can be excluded when the ABI index ranges from 0.9 to 1.3; TBI ≥ 0.75; and the dorsal foot artery Doppler waveform appears as a three-phase wave.(Strong; Low) 4 Perform at least one of the following bedside tests on the patient. Any one of them can help the doctor increase the probability of predicting the cure of ulcers by 25%. These tests include skin perfusion pressure ≥40mmHg and toe pressure ≥30.mmHg or transdermal oxygen pressure (TcPO2) ≥25mmHg.(Strong; Medium) 5 For patients with diabetic foot ulcers and PAD, the classification of wounds, ischemia, and foot infections (WIfI) is used to classify the management of amputation risk management and revascularization.(Strong; Medium) 6 Always consider emergency angiography and revascularization for diabetic foot ulcer patients with ankle pressures <50mmHg, ABI <0.5, toe pressure <30mmHg or TcPO2 <25mmHg.(Strong; Low) 7 Regardless of the results of bedside examinations, if patients with ulcers are given good care but cannot be cured within 4-6 weeks, consideration should be given to timely angiography.(Strong; Low) 8 Regardless of the results of the bedside examination, if the ulcer does not heal within 4-6 weeks despite being given the best treatment, it is necessary to consider the timely revascularization of patients with diabetic foot.(Strong; Low) 9 Diabetic microangiopathy should not be considered as the cause of poor healing in patients with diabetic foot ulcers. Other possibilities that may cause poor healing should be considered.(Strong; Low) 10 When lower limb vascular reconstruction is required, the patient's anatomical information can be obtained using any of the following methods: color Doppler ultrasound, computed tomography angiography, magnetic resonance angiography or intra-arterial digital subtractionAngiography.The entire lower extremity arterial circulation needs to be assessed, especially the anterior and posterior lateral and knee and ankle arteries.(Strong; Low) 11 When revascularizing patients with diabetic foot ulcers, the goal is to restore at least one foot vessel, and preferentially select the foot artery that directly supplies blood flow in the area of ​​the arterial ulcer.After surgery, evaluate its effectiveness and objectively measure the amount of perfusion.(Strong; Low) 12 Open or hybrid revascularization technology is superior. There is insufficient evidence to confirm which method of revascularization is more advantageous, based on the patient's PAD level, availability of autologous veins, patient comorbidities and local doctors.Level of expertise, etc.(Strong; Low) 13 Any center that treats diabetic foot ulcers should have appropriate professionals who need the expertise required for diagnosis and can diagnose and treat PAD in a timely manner. They can perform intravascular techniques and surgical bypass surgery.(Strong; Low) 14 Ensure that patients with diabetic foot ulcers undergoing revascularization surgery receive a multidisciplinary treatment team as part of a comprehensive care plan.(Strong; Low) 15 Emergency assessment and treatment of patients with the following symptoms or signs: PAD and patients with signs of foot infections because of their high risk of amputation.(Strong; Medium). 16 For patients with poor risk / benefit ratios and low probability of success, revascularization should be avoided.(Strong; Low) 17 All patients with diabetes and ischemic foot ulcers should be actively managed for cardiovascular risk factors, including smoking cessation, antihypertensive and prescription statins, and low-dose aspirin or clopidogrel.(Strong; Low) The above content is only authorized for exclusive use by, please do not reprint without the authorization of the copyright party.


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