背景:Charcot神经骨关节病(CNO)是一种罕见但破坏性的糖尿病并发症,与高发病率相关;然而,许多非脚专家都没有意识到这一点,导致漏诊和延误诊断。临床实践指南(CPG)已被证明可用于提高护理质量并规范糖尿病和糖尿病足护理的实践。然而,关于识别和管理活跃CNO的建议的一致性知之甚少。目的:这项研究的目的是回顾欧洲国家糖尿病CPGs对活动性CNO的诊断和管理,并评估其方法学的严密性和透明度。方法:进行了系统的搜索,以确定整个欧洲的糖尿病国家CPG。对任何语言的指南进行了审查,以探讨它们是否为活跃的CNO提供了定义和诊断建议,监测,和管理。方法的严密性和透明度使用评估指南的研究和评价(AGREE-II)工具进行评估,其中包括在六个领域中组织的23个关键项目,总体指南评估得分≥60%,被认为具有足够的推荐使用质量。每个指南都由两名评审员评估,并计算了AGREE-II分数的评分者间协议(肯德尔的W)。结果:17个CPG符合纳入标准。CNO内容的广度因指南而异(中位数(IQR)字数:327;Q1=151;Q3=790),53%提供了活性CNO的定义。82%和53%的人提供了诊断和监测建议,分别,卸载是最常见的管理建议(88%)。四项指南(24%)达到了推荐用于临床实践的阈值(≥60%),范围和目的领域得分最高(平均值(SD):67%,±23%)。其余领域的平均得分在19%和53%之间。评分者之间的一致性很强(W=0.882;p<0.001)。结论:欧洲国家糖尿病CPGs对活性CNO的建议有限。所有指南都显示了其方法的缺陷,建议整个欧洲的糖尿病CPG发展应采用更严格的方法。
Background: Charcot neuro-osteoarthropathy (CNO) is a rare but devastating complication of diabetes associated with high rates of morbidity; yet, many nonfoot specialists are unaware of it, resulting in missed and delayed diagnosis. Clinical practice
guidelines (CPGs) have proven useful in improving quality of care and standardizing practice in diabetes and diabetic foot care. However, little is known about the consistency in recommendations for identification and management of active CNO. Aim: The aim of this study is to review European national diabetes CPGs for the diagnosis and management of active CNO and to assess their methodological rigor and transparency. Methods: A systematic search was performed to identify diabetes national CPGs across Europe.
Guidelines in any language were reviewed to explore whether they provided a definition for active CNO and recommendations for diagnosis, monitoring, and management. Methodological rigor and transparency were assessed using the Appraisal of
Guidelines for Research and Evaluation (AGREE-II) tool, which comprises 23 key items organized within six domains with an overall
guideline assessment score of ≥ 60% considered to be of adequate quality to recommend use. Each
guideline was assessed by two reviewers, and inter-rater agreement (Kendall\'s W) was calculated for AGREE-II scores. Results: Seventeen CPGs met the inclusion criteria. Breadth of CNO content varied across guidelines (median (IQR) word count: 327; Q1 = 151; Q3 = 790), and 53% provided a definition for active CNO. Recommendations for diagnosis and monitoring were provided by 82% and 53%, respectively, with offloading being the most common management recommendation (88%). Four guidelines (24%) reached threshold for recommendation for use in clinical practice (≥ 60%) with the scope and purpose domain scoring highest (mean (SD): 67%, ± 23%). The remaining domains had average scores ranging between 19% and 53%. Inter-rater agreement was strong (W = 0.882; p < 0.001). Conclusions: European national CPGs for diabetes provide limited recommendations on active CNO. All guidelines showcased deficits in their methodology, suggesting that more rigorous methods should be employed for diabetes CPG development across Europe.