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.

. The management of diabetic foot: the new guidelines of the International Working Group on Diabetic Foot. The publication of the new guidelines on the diabetic foot are an opportunity for a fine-tuning of the (few) new developments, but of the soundness of the evidence and knowledge known so far. Compared to the previous 2019 guidelines, the 2023 update included the analysis of randomised clinical trials only, a more accurate application of the GRADE method, a leaner and more current bibliography, and an update of the strength of some recommendations from low to conditional. The real big news in the 2023 update is the publication of a specific guideline for the diagnosis and treatment of Charcot neuro-osteoarthropathy in people with diabetes, neuropathy and in the absence of skin lesions.

UNASSIGNED: Type 2 diabetes can lead to severe foot complications, making self-care education, guided by clinical guidelines, crucial. However, fragmented and dispersed recommendations challenge effective implementation of these guidelines. Bringing together recommendations and presenting them according to a self-care model can provide a solid framework and facilitate the interpretation of results.
UNASSIGNED: to map the international guidelines that provide recommendations to nurses to enable people with type 2 diabetes for foot self-care and synthesize the recommendations according to the key concepts of the middle-range theory of self-care for chronic diseases.
UNASSIGNED: A scoping review was undertaken, using the methodological guidance of the Joanna Briggs Institute.
UNASSIGNED: Databases were searched between September 2022 and June 2023, including PubMed, CINAHL, PsycINFO, Scopus, Web of Science Core Collection, ProQuest Dissertations and Theses Global, guideline websites and related professional association websites. The databases were chosen for their comprehensive coverage of the area.
UNASSIGNED: Eligible articles included guidance documents providing foot care recommendations for diabetes, published or updated between 2013 and 2023. Two reviewers summarized the recommendations presented in at least two guidelines according to the key concepts of the self-care model. The PRISMA-ScR checklist was used.
UNASSIGNED: Seventeen guidelines were included. In total, we synthesized 175 recommendations. The recommendations were framed in three dimensions and their respective categories: Self-care maintenance (education for prevention, control of risk factors, daily foot care, footwear, and socks), Self-care monitoring (foot inspection, detection of signs of infection, and detection of other diabetes-related foot disease complications), and Self-care management (responses to signs and symptoms, foot wound care, follow-up with health professionals, and health services).
UNASSIGNED: The main aspect of foot care revolves around daily care, including cleaning, moisturizing, nail care, selecting appropriate footwear, and regular inspection of both feet and footwear.

The diabetic foot interacts with anatomical, vascular, and neurological factors that challenge clinical practice. This study aimed to compile the primary scientific evidence based on a review of the main guidelines, in addition to articles published on the Embase, Lilacs, and PubMed platforms. The European Society of Cardiology system was used to develop recommendation classes and levels of evidence. The themes were divided into six chapters (Chapter 1 - Prevention of foot ulcers in people with diabetes; Chapter 2 - Pressure relief from foot ulcers in people with diabetes; Chapter 3 -Classifications of diabetic foot ulcers; Chapter 4 - Foot and peripheral artery disease; Chapter 5 - Infection and the diabetic foot; Chapter 6 - Charcot\'s neuroarthropathy). This version of the Diabetic Foot Guidelines presents essential recommendations for the prevention, diagnosis, treatment, and follow-up of patients with diabetic foot, offering an objective guide for medical practice.

In this podcast, we discuss the 2023 update of the International Working Group on the Diabetic Foot (IWGDF) Guidelines on the prevention of foot ulcers in people with diabetes. Prevention of foot ulcers is paramount, to reduce their large burden on patients and society. Nevertheless, many clinical guidelines do not cover prevention as a topic. The IWGDF Guidelines ensure that a full chapter is dedicated to ulcer prevention. In that chapter, the key cornerstones of prevention are outlined, as well as the importance of integrated preventative foot care. With this podcast, we aim to highlight the importance of ulcer prevention and the opportunities to incorporate recommendations into clinical practice. This hopefully stimulates clinicians and researchers to increase focus on ulcer prevention in diabetic foot disease.A podcast audio is available with this article.

Diabetic foot ulcers complicated with lower extremity vasculopathy possess the characteristics of high incidence, slow healing, and poor prognosis, which may eventually lead to amputation or even life-threatening if not treated properly. The treatment of complicated lower extremity vasculopathy is vital to improve the healing process of diabetic foot ulcers, which has gradually received attention in clinical practice. Recently, a number of clinical trials on diabetic foot ulcers complicated with lower extremity vasculopathy were reported. In order to further standardize the clinical diagnosis and treatment of diabetic foot ulcers complicated with lower extremity vasculopathy, an expert group headed by Burns and Trauma Branch of Chinese Geriatrics Society, Chinese Burn Association, and Wound Repair Professional Committee of Chinese Medical Doctor Association deliberated and compiled the National expert consensus on the diagnosis and surgical treatment of diabetic foot ulcers complicated with lower extremity vasculopathy (2024 version) together. This consensus is based on evidences from the literature, covers the disease characteristics, evidence-based evidence of clinical diagnosis and treatment, as well as the application of new technologies and new treatment approaches of diabetic foot ulcers complicated with lower extremity vasculopathy. The goal of this consensus is to provide clear guidance to practitioners on the best approaches for screening, diagnosing, and treating diabetic foot ulcers complicated with lower extremity vasculopathy in individuals, hoping to provide a normative clinical practice basis for medical staff engaged in the treatment of diabetic foot wounds.
糖尿病足溃疡合并下肢血管病变具有发病率高、愈合缓慢、预后差的特点，如不经规范治疗易导致截肢甚至危及生命。针对合并下肢血管病变的治疗对改善糖尿病足溃疡的愈合进程至关重要，在临床实践中逐渐得到重视。近年来，关于糖尿病足溃疡合并下肢血管病变的临床研究已见诸多报道，为了进一步规范临床诊疗，由中国老年医学学会烧创伤分会、中华医学会烧伤外科学分会、中国医师协会创面修复专业委员会牵头的专家组共同审议并编写了《糖尿病足溃疡合并下肢血管病变的外科诊疗全国专家共识（2024版）》。该共识以文献证据为基础，内容涵盖了糖尿病足溃疡合并下肢血管病变的疾病特征、临床诊疗循证证据以及新技术和新治疗方法的应用，旨在为临床工作者提供关于糖尿病足溃疡合并下肢血管病变最佳筛查和诊疗方法的明确指导，希望为从事糖尿病足创面治疗的医务人员提供规范性的临床实践依据。.

UNASSIGNED: IWGDF/IDSA Guidelines on the Diagnosis and Treatment of Diabetes-related Foot Infections RELEASE DATE: October 2, 2023 PRIOR VERSION: March 16, 2020 DEVELOPER: IWGDF Editorial Board FUNDING SOURCE: International Working Group on the Diabetic Foot (IWGDF), Infectious Diseases Society of America (IDSA) TARGET POPULATION: Adults with suspected or confirmed diabetes-related foot infections.

In this podcast the lead authors of the 2023 International Working Group on the Diabetic Foot (IWGDF) guideline on offloading treatments for diabetes-related foot ulcers briefly discuss why we need offloading treatments for people with diabetes-related foot ulcers, what the new international offloading guideline recommends, and where offloading treatment might go into the future.A podcast audio is available with this article.

BACKGROUND: In this podcast, we present the result of the 2023 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.
METHODS: These guidelines were based on a systematic review of the available literature that identified 28 classifications addressed in 149 articles and, subsequently, expert opinion using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. We first assessed the value of each system independently and, in the second stage, chose the best one or two to be used in each clinical scenario.
RESULTS: We recommend (1) for communication among healthcare professionals to use the Site, Ischaemia, Neuropathy, Bacterial infection, Area, Depth (SINBAD) classification (first option) or consider using Wound, Ischaemia, foot Infection (WIfI) system (alternative option, when the required equipment and level of expertise are 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; (2) for predicting the outcome of an ulcer in a specific individual: no existing system could be recommended; (3) for characterising a person with an infected ulcer: the use of the IDSA (Infection Diseases Society of America)/IWGDF (first option) classification or consider using the WIfI system (alternative option, when the required equipment and level of expertise are available and it is considered as feasible); (4) for characterising a person with peripheral artery disease: consider using the WIfI system as a means to stratify healing likelihood and amputation risk; (5) for the audit of outcome(s) of populations: the use of the SINBAD score.
CONCLUSIONS: Although there is no classification that fits all purposes, it is crucial that healthcare professionals standardize the way they characterise diabetes-related foot ulcers and guide their decision-making process by using validated classification systems.

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