背景:目前澳大利亚尚无预防糖尿病相关足部溃疡(DFU)的指南。一个国家专家小组旨在系统地确定和调整适当的国际准则以适应澳大利亚的情况,以创建新的澳大利亚循证指南,以预防首次和/或反复出现的DFU。这些准则将首次考虑农村和偏远地区,原住民和托雷斯海峡岛民。
方法:遵循国家卫生和医学研究委员会的程序,以使有关DFU预防的国际指南适应澳大利亚的健康状况。这包括对公共数据库的搜索,此后,国际糖尿病足工作组(IWGDF)预防指南被认为是最合适的适应。使用ADAPTE和GDE系统评估了IWGDF的16项预防建议,以决定是否应采用这些建议,适应或排除新的澳大利亚指南。参考澳大利亚的情况,重新评估了证据的质量和推荐等级的强度。该指南经过了公众咨询,进一步修订,并获得国家高峰机构的批准。
结果:在IWGDF的16项原始预防建议中,九人被收养,6人被改编,1人被排除。建议以与IWGDF风险等级相对应的间隔评估所有DFU风险增加的人。对于那些风险增加的人,关于适当的足部保护的结构化教育,检查,鞋类,承重活动,和足部自我保健建议。矫形干预和/或医疗级鞋类的处方,提供综合足部护理,和足部皮肤温度的自我监测(视经过验证的情况而定,在澳大利亚可用的用户友好且负担得起的系统)也可能有助于防止DFU。如果上述推荐的非手术治疗失败,可以考虑使用各种手术干预措施来预防DFU.
结论:这一新的澳大利亚基于证据的DFU预防指南,得到10个国家高峰机构的认可,为澳大利亚相关卫生专业人员和消费者提供预防DFU的具体建议。遵循这些建议,应在澳大利亚取得更好的DFU预防成果。
BACKGROUND: There are no current Australian
guidelines on the prevention of diabetes-related foot ulceration (DFU). A national expert panel aimed to systematically identify and adapt suitable international
guidelines to the Australian context to create new Australian evidence-based guidelines on prevention of first-ever and/or recurrent DFU. These guidelines will include for the first-time considerations for rural and remote, and Aboriginal and Torres Strait Islander peoples.
METHODS: The National Health and Medical Research Council procedures were followed to adapt suitable international guidelines on DFU prevention to the Australian health context. This included a search of public databases after which the International Working Group on the Diabetic Foot (IWGDF) prevention
guideline was deemed the most appropriate for adaptation. The 16 IWGDF prevention recommendations were assessed using the ADAPTE and GRADE systems to decide if they should be adopted, adapted or excluded for the new Australian guideline. The quality of evidence and strength of recommendation ratings were re-evaluated with reference to the Australian context. This
guideline underwent public consultation, further revision, and approval by national peak bodies.
RESULTS: Of the 16 original IWGDF prevention recommendations, nine were adopted, six were adapted and one was excluded. It is recommended that all people at increased risk of DFU are assessed at intervals corresponding to the IWGDF risk ratings. For those at increased risk, structured education about appropriate foot protection, inspection, footwear, weight-bearing activities, and foot self-care is recommended. Prescription of orthotic interventions and/or medical grade footwear, providing integrated foot care, and self-monitoring of foot skin temperatures (contingent on validated, user-friendly and affordable systems becoming available in Australia) may also assist in preventing DFU. If the above recommended non-surgical treatment fails, the use of various surgical interventions for the prevention of DFU can be considered.
CONCLUSIONS: This new Australian evidence-based
guideline on prevention of DFU, endorsed by 10 national peak bodies, provides specific recommendations for relevant health professionals and consumers in the Australian context to prevent DFU. Following these recommendations should achieve better DFU prevention outcomes in Australia.