Guidelines on the classification of foot ulcers in people with diabetes (IWGDF 2023 update)
Issued Date
2023-01-01
Resource Type
ISSN
15207552
eISSN
15207560
Scopus ID
2-s2.0-85158013446
Journal Title
Diabetes/Metabolism Research and Reviews
Rights Holder(s)
SCOPUS
Bibliographic Citation
Diabetes/Metabolism Research and Reviews (2023)
Suggested Citation
Monteiro-Soares M., Hamilton E.J., Russell D.A., Srisawasdi G., Boyko E.J., Mills J.L., Jeffcoate W., Game F. Guidelines on the classification of foot ulcers in people with diabetes (IWGDF 2023 update). Diabetes/Metabolism Research and Reviews (2023). doi:10.1002/dmrr.3648 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/82789
Title
Guidelines on the classification of foot ulcers in people with diabetes (IWGDF 2023 update)
Author's Affiliation
Siriraj Hospital
UWA Medical School
University Hospitals of Derby and Burton NHS Foundation Trust
Fiona Stanley Hospital
VA Puget Sound Health Care System
University of Washington School of Medicine
Nottingham University Hospitals NHS Trust
University of Leeds, School of Medicine
Faculdade de Medicina da Universidade do Porto (FMUP)
Leeds Teaching Hospitals NHS Trust
Faculty of Medicine Siriraj Hospital, Mahidol University
Universidade do Porto
Baylor College of Medicine
Portuguese Red Cross Health School
UWA Medical School
University Hospitals of Derby and Burton NHS Foundation Trust
Fiona Stanley Hospital
VA Puget Sound Health Care System
University of Washington School of Medicine
Nottingham University Hospitals NHS Trust
University of Leeds, School of Medicine
Faculdade de Medicina da Universidade do Porto (FMUP)
Leeds Teaching Hospitals NHS Trust
Faculty of Medicine Siriraj Hospital, Mahidol University
Universidade do Porto
Baylor College of Medicine
Portuguese Red Cross Health School
Other Contributor(s)
Abstract
Background: This publication represents a scheduled update of the 2019 guidelines of the International Working Group of the Diabetic Foot (IWGDF) addressing the use of systems to classify foot ulcers in people with diabetes in routine clinical practice. The guidelines are based on a systematic review of the available literature that identified 28 classifications addressed in 149 articles and, subsequently, expert opinion using the GRADE methodology. Methods: First, we have developed a list of classification systems considered as being potentially adequate for use in a clinical setting, through the summary of judgements for diagnostic tests, focussing on the usability, accuracy and reliability of each system to predict ulcer-related complications as well as use of resources. Second, we have determined, following group debate and consensus, which of them should be used in specific clinical scenarios. Following this process, in a person with diabetes and a foot ulcer we recommend: (a) for communication among healthcare professionals: to use the SINBAD (Site, Ischaemia, Bacterial infection, Area and Depth) system (first option) or consider using WIfI (Wound, Ischaemia, foot Infection) system (alternative option, when the required equipment and level of expertise is available and it is considered feasible) and in each case the individual variables that compose the systems should be described rather than a total score; (b) for predicting the outcome of an ulcer in a specific individual: no existing system could be recommended; (c) for characterising a person with an infected ulcer: the use of the IDSA/IWGDF classification (first option) or consider using the WIfI system (alternative option, when the required equipment and level of expertise is available and it is considered as feasible); (d) for characterising a person with peripheral artery disease: consider using the WIfI system as a means to stratify healing likelihood and amputation risk; (e) for the audit of outcome(s) of populations: the use of the SINBAD score. Conclusions: For all recommendations made using GRADE, the certainty of evidence was judged, at best, as being low. Nevertheless, based on the rational application of current data this approach allowed the proposal of recommendations, which are likely to have clinical utility.