Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
Department of Podiatry, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
J Foot Ankle Res. 2022 Jul 6;15(1):53. doi: 10.1186/s13047-022-00534-7.
There are no current Australian guidelines on the prevention of diabetes-related foot ulceration (DFU). A national expert panel aimed to systematically identify and adapt suitable international guidelines to the Australian context to create new Australian evidence-based guidelines on prevention of first-ever and/or recurrent DFU. These guidelines will include for the first-time considerations for rural and remote, and Aboriginal and Torres Strait Islander peoples.
The National Health and Medical Research Council procedures were followed to adapt suitable international guidelines on DFU prevention to the Australian health context. This included a search of public databases after which the International Working Group on the Diabetic Foot (IWGDF) prevention guideline was deemed the most appropriate for adaptation. The 16 IWGDF prevention recommendations were assessed using the ADAPTE and GRADE systems to decide if they should be adopted, adapted or excluded for the new Australian guideline. The quality of evidence and strength of recommendation ratings were re-evaluated with reference to the Australian context. This guideline underwent public consultation, further revision, and approval by national peak bodies.
Of the 16 original IWGDF prevention recommendations, nine were adopted, six were adapted and one was excluded. It is recommended that all people at increased risk of DFU are assessed at intervals corresponding to the IWGDF risk ratings. For those at increased risk, structured education about appropriate foot protection, inspection, footwear, weight-bearing activities, and foot self-care is recommended. Prescription of orthotic interventions and/or medical grade footwear, providing integrated foot care, and self-monitoring of foot skin temperatures (contingent on validated, user-friendly and affordable systems becoming available in Australia) may also assist in preventing DFU. If the above recommended non-surgical treatment fails, the use of various surgical interventions for the prevention of DFU can be considered.
This new Australian evidence-based guideline on prevention of DFU, endorsed by 10 national peak bodies, provides specific recommendations for relevant health professionals and consumers in the Australian context to prevent DFU. Following these recommendations should achieve better DFU prevention outcomes in Australia.
目前澳大利亚尚无关于预防糖尿病相关足部溃疡（DFU）的指南。一个国家专家小组旨在系统地识别和调整适合澳大利亚国情的国际指南，以制定新的澳大利亚预防首次和/或复发性 DFU 的循证指南。这些指南将首次考虑农村和偏远地区以及原住民和托雷斯海峡岛民的情况。
遵循澳大利亚国家卫生和医学研究委员会的程序，将适合澳大利亚卫生情况的 DFU 预防国际指南进行调整。这包括在公共数据库中进行搜索，之后认为国际糖尿病足工作组（IWGDF）的预防指南最适合进行调整。使用 ADAPTE 和 GRADE 系统评估 16 项 IWGDF 预防建议，以确定是否应采纳、调整或排除这些建议用于新的澳大利亚指南。根据澳大利亚的情况，重新评估证据质量和推荐强度评级。该指南经过公众咨询、进一步修订和国家最高机构的批准。
在最初的 16 项 IWGDF 预防建议中，有 9 项被采纳，6 项被调整，1 项被排除。建议对所有有 DFU 风险的人按照 IWGDF 风险评级进行评估。对于高风险人群，建议进行有关适当足部保护、检查、鞋类、负重活动和足部自我护理的结构化教育。建议开具矫形干预和/或医疗级鞋类的处方，提供综合足部护理，以及自我监测足部皮肤温度（取决于在澳大利亚是否有经过验证、易于使用且价格合理的系统），这也有助于预防 DFU。如果上述推荐的非手术治疗失败，可以考虑使用各种手术干预来预防 DFU。
本新的澳大利亚基于循证的 DFU 预防指南得到 10 个国家最高机构的认可，为澳大利亚相关卫生专业人员和消费者提供了预防 DFU 的具体建议。遵循这些建议应能在澳大利亚取得更好的 DFU 预防效果。
