Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)
Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)
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DOI：
10.1002/dmrr.3269
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发表时间：
2020-03-01
影响因子：
8
通讯作者：
van Netten, Jaap J.
中科院分区：
文献类型：
--
作者：
Bus, Sicco A.;Lavery, Lawrence A.;van Netten, Jaap J.
国际糖尿病足工作组 (IWGDF) 自 1999 年起就发布了糖尿病足病预防和管理的循证指南。该指南针对糖尿病患者足部溃疡的预防，并更新了 2015 年 IWGDF 预防指南。我们遵循 GRADE 方法以 PICO 格式设计临床问题和至关重要的结果，对医学科学文献进行系统回顾，并撰写建议及其理由。这些建议基于系统评价中发现的证据质量、无法获得证据的专家意见，以及对干预措施相关益处和危害、患者偏好、可行性和适用性以及成本的权衡。我们建议每年对溃疡风险极低的人进行保护性感觉丧失和外周动脉疾病的筛查，对风险较高的人以更高的频率筛查其他风险因素。为了预防足部溃疡，请对高危患者进行适当的足部自我护理教育，并治疗足部的任何溃疡前症状。指导中高风险患者穿着合适的治疗鞋，并考虑指导他们监测足部皮肤温度。处方在行走过程中具有缓解足底压力作用的治疗鞋，以防止足底溃疡复发。对于活动性或即将发生的溃疡非手术治疗失败的患者，请考虑手术干预；我们建议不要使用神经减压手术。为高危患者提供综合足部护理，以预防溃疡复发。遵循这些建议将有助于医疗保健专业人员为有足部溃疡风险的糖尿病患者提供更好的护理，增加无溃疡天数，并减轻糖尿病足病的患者和医疗保健负担。
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 prevention of foot ulceration in persons with diabetes and updates the 2015 IWGDF prevention guideline. We followed the GRADE methodology to devise clinical questions and critically important outcomes in the 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 recommend to screen a person at very low risk for ulceration annually for loss of protective sensation and peripheral artery disease and persons at higher risk at higher frequencies for additional risk factors. For preventing a foot ulcer, educate the at-risk patient about appropriate foot self-care and treat any pre-ulcerative sign on the foot. Instruct moderate-to-high risk patients to wear accommodative properly fitting therapeutic footwear, and consider instructing them to monitor foot skin temperature. Prescribe therapeutic footwear that has a demonstrated plantar pressure relieving effect during walking to prevent plantar foot ulcer recurrence. In patients that fail non-surgical treatment for an active or imminent ulcer, consider surgical intervention; we suggest not to use a nerve decompression procedure. Provide integrated foot care for high-risk patients to prevent ulcer recurrence. Following these recommendations will help health care professionals to provide better care for persons with diabetes at risk of foot ulceration, to increase the number of ulcer-free days, and to reduce the patient and health care burden of diabetic foot disease.