Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
Internal Medical Services, Ballarat Health Services, Ballarat, Australia.
J Foot Ankle Res. 2022 Jun 9;15(1):47. doi: 10.1186/s13047-022-00545-4.
Diabetes-related foot infections cause substantial morbidity and mortality, both globally and in Australia. There is a need for up-to-date evidence-based guidelines to ensure optimal management of patients with diabetes-related foot infections. We aimed to identify and adapt high quality international guidelines to the Australian context to become the new Australian evidence-based guideline for people with a diabetes-related foot infection.
Following Australian National Health and Medical Research Council (NHMRC) procedures we identified the 2019 International Working Group on the Diabetic Foot (IWGDF) guidelines as suitable for adaptation to the Australian context. Guidelines were screened, assessed and judged by an expert panel for the Australian context using the guideline adaptation frameworks ADAPTE and Grading of Recommendations Assessment, Development and Evaluation (GRADE). Judgements led to recommendations being adopted, adapted or excluded, with additional consideration regarding their implementation, monitoring and future research for the Australian context. Clinical pathways were then developed to assist implementation.
Of 36 original diabetes-related foot infection IWGDF sub-recommendations, 31 were adopted, four were adapted and one was excluded. Adaption was primarily undertaken due to differences or clarification of the sub-recommendations' intended population. One sub-recommendation was excluded due to substantial differences in judgements between the panel and IWGDF and unacceptable heterogeneity of the target population. Therefore, we developed 35 evidence-based sub-recommendations for the Australian context that should guide best practice diagnosis and management of people with diabetes-related foot infection in Australia. Additionally, we incorporated these sub-recommendations into two clinical pathways to assist Australian health professionals to implement these evidence-based sub-recommendations into clinical practice. The six guidelines and the full protocol can be found at: https://www.diabetesfeetaustralia.org/new-guidelines/ .
A new national guideline for the diagnosis and management of people with diabetes-related foot infections were successfully developed for the Australian context. In combination with simplified clinical pathway tools they provide an evidence-based framework to ensure best management of individuals with diabetes-related foot infections across Australia and highlight considerations for implementation and monitoring.
糖尿病相关足部感染在全球和澳大利亚都造成了大量的发病率和死亡率。需要有最新的循证指南，以确保对糖尿病相关足部感染患者进行最佳管理。我们的目的是确定并调整高质量的国际指南，以适应澳大利亚的情况，成为新的澳大利亚基于证据的糖尿病相关足部感染患者指南。
根据澳大利亚国家卫生和医学研究委员会（NHMRC）的程序，我们确定 2019 年国际糖尿病足工作组（IWGDF）指南适合适应澳大利亚的情况。使用指南调整框架 ADAPTE 和推荐评估、制定和评估分级（GRADE），由专家组对指南进行筛选、评估和判断，以确定其是否适合澳大利亚的情况。判断结果导致建议被采纳、调整或排除，同时还考虑了其在澳大利亚的实施、监测和未来研究。然后制定临床路径以协助实施。
在最初的 36 项糖尿病相关足部感染 IWGDF 子建议中，有 31 项被采纳，4 项被调整，1 项被排除。调整主要是由于子建议的目标人群存在差异或建议内容需要澄清。由于专家组与 IWGDF 之间的判断存在较大差异，且目标人群的异质性不可接受，因此有一项子建议被排除。因此，我们为澳大利亚制定了 35 项基于证据的子建议，这些建议应指导澳大利亚的最佳实践，诊断和管理糖尿病相关足部感染患者。此外，我们将这些子建议纳入两个临床路径中，以帮助澳大利亚的卫生专业人员将这些基于证据的子建议纳入临床实践。可以在以下网址找到六份指南和完整的方案：https://www.diabetesfeetaustralia.org/new-guidelines/。
为澳大利亚制定了新的国家指南，用于诊断和管理糖尿病相关足部感染患者。结合简化的临床路径工具，它们为确保澳大利亚各地糖尿病相关足部感染患者得到最佳管理提供了循证框架，并强调了实施和监测的考虑因素。
