A Critical Evaluation of Existing Diabetic Foot Screening Guidelines.

NewsBot · Nov 24, 2024

Effectiveness of screening for foot complications in people with diabetes – A systematic review
Aleksandra Staniszewska et al
Journal of Diabetes and its Complications; Volume 38, Issue 11, November 2024, 108865

Highlights
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People with diabetes have a six-fold risk of limb loss compared to the general population
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Annual foot checks are offered in England and Scotland to reduce the risk of limb loss
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Only five recent studies assessed the effectiveness of structured foot screening
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The low number and quality of studies has resulted in variable effect of screening on clinical outcomes
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New robust evidence is needed to justify population-based foot screening in people with diabetes to guide use of resources
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Background
A quarter of people with diabetes develop foot ulcer in their lifetime and are six times more likely to require a major lower limb amputation compared to the general population. Risk stratification tools can reliably identify those at the highest risk of ulceration, but it remains unclear if screening for foot complications can prevent limb loss in people with diabetes.
Aims
The aim of this systematic review was to determine whether population-based foot screening in people with diabetes reduces lower limb complications as assessed by development of foot ulceration, minor and major lower limb amputations, hospitalisation, or death.
Methods
MEDLINE, Embase, Emcare and CINAHL databases were searched to identify randomised and non-randomised controlled trials and observational studies (cohort, case-control and cross-sectional surveys). The screening process, study quality assessment and data extraction were performed by two independent reviewers.
Results
Following abstract screening and assessment for eligibility, five out of 10,771 identified studies were included in the analysis. Of these studies, one demonstrated 24 % reduction in development of new ulceration following introduction of screening. Major amputations decreased by between 17 and 96 % in three studies. Hospitalisation rates were contradictory, with one study showing doubling in hospital admissions and another one reduction by 33 %. One study demonstrated no impact of screening on minor or major amputation rates. None of the studies addressed the effect of foot screening on all-cause mortality.
Conclusions
The number and quality of studies to support population-based foot screening to prevent lower limb complications in people with diabetes is low. Current evidence suggests variable impact of screening on important clinical outcomes.
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NewsBot · Nov 25, 2024

Diabetic Foot Ulcer beyond Wound Closure: Clinical Practice Guideline
Deborah M Wendland et al
Phys Ther. 2024 Nov 22

A total of 37.3 million Americans have diabetes, and 96 million more have prediabetes. Hyperglycemia, the hallmark of diabetes, increases the risk for diabetes-related complications, including skin breakdown and cardiovascular disease. Many clinical practice guidelines exist, but there are gaps regarding the best approaches to assess physical fitness and mobility in adults with diabetes; incorporate exercise into the care plan; and reload the diabetic foot after ulcer closure has occurred to avoid ulcer reoccurrence. The purpose of this clinical practice guideline was to review and assess previously published guidelines and address gaps within the guidelines specific to the following: best screening tools/tests and interventions to prevent a future reulceration, best screening tools and interventions to assess and address mobility impairments, best tools to measure and interventions to address reduced physical fitness and activity, best approach to reloading the foot after ulceration closure and, finally, whether improvement in physical fitness will positively change quality of life and health care costs. The Guidelines Development Group performed a systematic literature search and review of the literature. A total of 701 studies were identified. Following duplicate removal and exclusion for irrelevance, 125 studies underwent full-text review and 38 studies were included. Recommendations were developed using a software assistant created specifically for guideline recommendation development. Recommendations resulted for physical fitness and activity inclusion and measurement for adults with diabetes and with or without foot ulceration. Exercise and physical activity should be prescribed according to the physiologic response of an adult with diabetes to exercise and preferences for optimizing long-term quality of life and reduce health care costs. Reloading following diabetic foot ulcer closure should include maximal offloading, especially during the first 3 months; loading should be titrated using a footwear schedule. Further research is necessary in the areas of exercise in the wound healing process and the assessment of methods to reload a newly reepithelialized ulcer to prevent recurrence.
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NewsBot · Feb 16, 2025

Implementation of evidence-based foot screening in people with diabetes: A scoping review
Jemma M Houghton et al
J Diabetes Complications. 2025 Feb 12;39(3):108972.

Background: Recommendations to prevent diabetes ulceration and amputation include an annual foot check, primarily screening for sensation and circulation. Using these simple, evidence-based components is vital to identifying complications early, assessing risk, and managing care to prevent or delay amputations. However, routine implementation of these assessments is suboptimal and approaches to their integration remain poorly understood.

Aim: We aimed to identify and synthesize information on the factors affecting implementation of simple evidence-based diabetes foot screening.

Methods: We reviewed published and grey literature using a blinded two-stage process by two independent reviewers. Included studies were primary research that implemented or improved foot screening for adults with type 1 or 2 diabetes, assessing at least one of the following: 10-g monofilament sensitivity, pedal pulse palpation, or history of ulceration or amputation. A thematic synthesis approach was used.

Results: We screened 5133 titles and abstracts, reviewed 102 full-text articles, and included 26 studies in the final analysis. We identified four key themes: (1) Existing diabetes screening (i.e. retinal screening) or treatment interventions (i.e. medication collection) provide opportunities for synergistic integration; (2) Annual event-based foot screening (e.g. on World Diabetes Day) in lower resource settings provides community-focused preventative care; (3) Further opportunities to increase access to foot screening include self-administered screening and screening in complex residential settings; (4) Healthcare provider champions are essential for local foot screening implementation in primary and secondary care.

Conclusion: Further research should evaluate the issues identified in these four themes, in different contexts, and with support of implementation frameworks.
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A Critical Evaluation of Existing Diabetic Foot Screening Guidelines.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

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Share This Page

A Critical Evaluation of Existing Diabetic Foot Screening Guidelines.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Critical Thinking

Iatrogenic injury and critical limb iscahemia

“Switch” Critical to Wound Healing

Critical limb ischemia

Critical limb ischemia criteria are not applicable to diabetic foot

'Time critical' rapid amputation using fire service hydraulic cutting equipment

Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis--critical appr

Share This Page

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