New Aussie guidelines for diabetes-related foot disease

New Australian-based guidelines for diabetes-related foot disease have been summarized in an article recently published online in the Medical Journal of Australia, coinciding with World Diabetes Day on 14 November 2023.

The guidelines, developed and published by Diabetes Feet Australia, are the first new Australian guidelines since 2011 and have been endorsed by 10 national peak bodies.

"We've observed over the years that well-directed implemented guidelines are critical to underpinning quality care and there are a number of areas of the guidelines that have been improved and updated compared with the ones from 2011," guideline summary co-author Professor Stephen Twigg.

"Practically developed clinical care guidelines that are up to date can really make a positive difference to health care outcomes and, in this case, for people with foot disease," he said.

The theme of this year's World Diabetes Day is "Know your risk, know your response," encouraging people to know their risk level and what to do to support prevention, early diagnosis and timely treatment.

Diabetes-related foot disease is a leading cause of hospitalization, amputation, disability and health care costs in Australia.

It is estimated that 300,000 Australians are at risk of developing diabetes-related foot disease annually.

The guidelines at a glance

The 98 recommendations made across six new guidelines for the general medical audience have been summarized in the MJA:

• prevention—screening, education, self-care, footwear, and treatments to prevent diabetic foot disease;
• classification—classifications systems for ulcers, infection, ischemia and auditing;
• peripheral artery disease—examinations and imaging for diagnosis, severity classification, and treatments;
• infection—examinations, cultures, imaging and inflammatory markers for diagnosis, severity classification, and treatments;
• offloading—pressure offloading treatments for different ulcer types and locations; and
• wound healing—debridement, wound dressing selection

The changes include a new risk stratification system for screening of people without diabetes-related foot disease, with more specific self-monitoring, footwear prescription, surgical treatments and activity management practices for those at increased risk.

For people with diabetes-related foot disease, there are new ulcer, infection and peripheral artery disease classification systems, with more specific recommendations to resolve diabetes-related foot disease.

Diabetes Feet Australia has created an interactive platform for the guidelines, which health care practitioners can use with their patients.

"GPs or podiatrists or nurses with a patient with diabetes-related foot disease in front of them can click on these pathways to identify the recommendations that apply for that particular patient in terms of assessment, education and management," guideline summary co-author Associate Professor Pete Lazzarini said.