International collaboration unveils updated PAD guidelines in diabetic foot ulcers

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New guidelines cover

The International Working Group on the Diabetic Foot (IWGDF), the European Society for Vascular Surgery (ESVS) and the Society for Vascular Surgery (SVS) have jointly released updated guidelines for the diagnosis, prognosis and management of peripheral arterial disease (PAD) in individuals with diabetes mellitus and a foot ulcer. 

The guidelines were developed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations) methodology and were supported by several systematic reviews organized by Vivienne Chuter, MD, professor of podiatry at the University of Newcastle, Australia. The aim is to provide consistent, multidisciplinary and inter-societal recommendations applicable to clinicians everywhere. 

SVS President Joseph Mills, MD, affiliated with Baylor College of Medicine in Houston, who co-chaired the writing committee along with Rob Fitridge, MD, of the University of Adelaide, Australia (IWGDF) and Rob Hinchliffe, MD, of the University of Bristol, England (ESVS), shed light on the significant developments. 

“This collaboration, with extensive input from multiple specialties, represents a critical step forward in addressing diabetes-related foot complications across the globe,” Mills said. 

Building upon the 2019 IWGDF guideline, the updated guidelines cover a spectrum of crucial aspects of diabetic foot care. The writing committee, consisting of 18 experts from various disciplines, including vascular surgery, angiology, interventional radiology, vascular medicine, endocrinology, epidemiology and podiatry, worked collaboratively to develop recommendations that span the entire continuum of care. 

The guidelines were jointly published in the Journal of Vascular Surgery, the European Journal of Vascular and Endovascular Surgery and Diabetes/Metabolism Research and Reviews. 

The guidelines include five critical recommendations for diagnosing PAD in individuals with diabetes, both with and without a foot ulcer or gangrene. Additionally, the guidelines offer five recommendations for prognosis, aiding in estimating the likelihood of healing and amputation outcomes in those with diabetes and a foot ulcer or gangrene. 

A comprehensive set of 15 recommendations focuses on PAD treatment, prioritizing individuals for revascularization, selecting appropriate procedures and post-surgical care. The writing committee, conscious of potential gaps in current evidence, also highlighted key research questions for further exploration. 

Mills stressed the importance of these guidelines in improving patient care and reducing the burden of diabetes-related foot complications. “By becoming familiar with and following these recommendations, healthcare professionals can enhance their ability to provide better care to individuals with diabetes, ultimately improving outcomes,” he said. 

Mills indicated that the international, multidisciplinary approach to developing these guidelines reflects a concerted effort to address the diverse needs of patients with diabetes around the world. 

“As healthcare professionals begin to implement these updated recommendations, we hope to substantially diminish the burden of diabetes-related foot complications, reduce preventable, major limb amputations and improve outcomes for individuals worldwide,” said Mills. 

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