Guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update).
Open accessAbstract
AIMS: Principles of wound management, including debridement, wound bed preparation, and newer technologies involving alternation of wound physiology to facilitate healing, are of utmost importance when attempting to heal a chronic diabetes-related foot ulcer. However, the rising incidence and costs of diabetes-related foot ulcer management necessitate that interventions to enhance wound healing of chronic diabetes-related foot ulcers are supported by high-quality evidence of efficacy and cost effectiveness when used in conjunction with established aspects of gold-standard multidisciplinary care. This is the 2023 International Working Group on the Diabetic Foot (IWGDF) evidence-based guideline on wound healing interventions to promote healing of foot ulcers in persons with diabetes. It serves as an update of the 2019 IWGDF guideline. MATERIALS AND METHODS: We followed the GRADE approach by devising clinical questions and important outcomes in the Patient-Intervention-Control-Outcome (PICO) format, undertaking a systematic review, developing summary of judgements tables, and writing recommendations and rationale for each question. Each recommendation is based on the evidence found in the systematic review and, using the GRADE summary of judgement items, including desirable and undesirable effects, certainty of evidence, patient values, resources required, cost effectiveness, equity, feasibility, and acceptability, we formulated recommendations that were agreed by the authors and reviewed by independent experts and stakeholders. RESULTS: From the results of the systematic review and evidence-to-decision making process, we were able to make 29 separate recommendations. We made a number of conditional supportive recommendations for the use of interventions to improve healing of foot ulcers in people with diabetes. These include the use of sucrose octasulfate dressings, the use of negative pressure wound therapies for post-operative wounds, the use of placental-derived products, the use of the autologous leucocyte/platelet/fibrin patch, the use of topical oxygen therapy, and the use of hyperbaric oxygen. Although in all cases it was stressed that these should be used where best standard of care was not able to heal the wound alone and where resources were available for the interventions. CONCLUSIONS: These wound healing recommendations should support improved outcomes for people with diabetes and ulcers of the foot, and we hope that widescale implementation will follow. However, although the certainty of much of the evidence on which to base the recommendations is improving, it remains poor overall. We encourage not more, but better quality trials including those with a health economic analysis, into this area.
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Toe systolic blood pressure measurement is 86% sensitive and 58% specific.
“Toe systolic blood pressure 46,47 Measurement of systolic blood pressure at the toe 86% sensitive; 58% specific”
From Diabetic Foot Ulcers (2023) · cites this paper as [47]
The guideline discusses vascular measures such as the ankle-brachial index and transcutaneous oxygen pressure in §4.1.5, but the passages found do not report diagnostic performance for toe systolic blood pressure. Searches for “toe systolic blood pressure,” “toe pressure,” “86%,” and “58%” found no passage supporting the claimed sensitivity or specificity (page numbers unavailable). (LLM, conf=0.74)
Experimental — accuracy not yet measuredToe systolic blood pressure <30 mm Hg is associated with 2.09-fold higher relative risk of nonhealing after partial foot amputation compared with values ≥30 mm Hg (relative risk, 2.09; 95% CI, 1.37-3.20; P =.001).
“Toe systolic blood pressure <30 mm Hg is associated with 2.09-fold higher relative risk of nonhealing after partial foot amputation compared with values ≥30 mm Hg (relative risk, 2.09; 95% CI, 1.37-3.20;P =.001).”
From Diabetic Foot Ulcers (2023) · cites this paper as [47]
The discussion of postoperative wounds (section 4.7.5; page unavailable) addresses negative-pressure wound therapy after partial foot amputation, not toe blood pressure as a predictor of nonhealing. Searches for toe systolic pressure, the 30 mm Hg threshold, and the reported risk ratio and confidence interval found no passage supporting the claim in our copy. (LLM, conf=0.75)
Experimental — accuracy not yet measured
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10-Methoxy-leonurine accelerated wound healing through ErbB4/PI3K-AKT pathway
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- Authors
- Chen, P., Vilorio, N. C., Dhatariya, K., Jeffcoate, W., Lobmann, R., McIntosh, C., Piaggesi, A., Steinberg, J., Vas, P., Viswanathan, V., Wu, S., & Game, F.
- Affiliations
- Joondalup Health Campus Ramsay Healthcare Australia Joondalup Western Australia Australia
- Department of Diabetology Diabetic Foot Unit Plaza de la Salud General Hospital Santo Domingo Dominican Republic
- University of East Anglia (GB)
- Retired Physician Nottingham UK
- Klinikum Stuttgart (DE)
- Ollscoil na Gaillimhe – University of Galway (IE)
- University of Pisa (IT)
- Georgetown University (US)
- King's College Hospital NHS Foundation Trust (GB)
- M.V. Hospital for Diabetes and Diabetes Research Centre (IN)
- Rosalind Franklin University of Medicine and Science (US)
- University Hospitals of Derby and Burton NHS Foundation Trust Derby UK
- ORCID
- Venue
- Diabetes/Metabolism Research and Reviews
- Publisher
- Wiley
- Published
- 2023-05-25
- Volume
- 40
- Issue
- 3
- Pages
- e3644-e3644
- ISSN
- 1520-7552 (ISSN-L)
- 1520-7560
- OpenAlex
- W4378347981
- Cited by
- 246
- References
- 256
- Citations by year
- 2026: 107 · 2025: 69 · 2024: 45 · 2023: 25
- FWCI
- 8.84
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes/Metabolism Research and Reviews (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- University of Tasmania
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Rehabilitation › Wound Healing and Treatments
- Health Sciences › Medicine › Dermatology › Skin Diseases and Diabetes
- Keywords
- diabetic foot ulcer, wound healing, wound care, debridement, wound bed preparation, negative pressure wound therapy, hyperbaric oxygen therapy, topical oxygen therapy, cost-effectiveness, multidisciplinary care
- MeSH terms
- Humans, Wound Healing, Practice Guidelines as Topic, Diabetic Foot
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